Gulf War Illness (GWI) is a complex, poorly understood illness characterized by many symptoms, including fatigue after exertion, sleep and mood problems, difficulty concentrating, difficulty thinking and finding words, and musculoskeletal pain. Individuals often present with many symptoms, some of them severe and disabling, and with additional medical diagnoses, including chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, digestive complaints, and mood-related psychiatric disorders, such as depression, post-traumatic stress disorder, and other anxiety disorders. Of the 700,000 service personnel deployed to the Persian Gulf, at least one-fourth of the veterans of the first Gulf War (Operation Desert Shield/Storm, years 1990-1991) are affected by GWI. Many veterans have received treatment directed at their symptoms, but at 5- and 10-year follow-ups, many reported their symptoms remained, some of them severe and disabling. Clearly, an effective treatment for these conditions would be of great benefit to those who were injured during their military service.

In early 2013, our study team successfully finished a project funded by the Congressionally Directed Medical Research Programs titled, "The Effectiveness of Acupuncture in the Treatment of Gulf War Illness." The goal of this study was to identify whether acupuncture is an effective treatment for Gulf War Syndrome. Our results at this time support that acupuncture is an effective treatment, improving physical function to a meaningful extent; that is, we found statistically and clinically significant improvements in physical function following 6 months of bi-weekly treatment. We also found significant reductions in pain. Further, over 96% of the veteran participants reported that they liked the treatment, their practitioners, and felt confident recommending acupuncture to a friend or family member.

There are many different symptoms associated with GWI. We asked the participants to tell us if they had any of the known symptoms, and also generally about their health and well-being. In this way we can see if the acupuncture helps some symptoms in particular, with the goal of finding the best type of treatment for all veterans with GWI. This extra measurement will also help us to look at how veterans get better and how acupuncture might work. This type of information can be used to help other veterans, not just those with GWI.

Objectives of current application: This three-year project has three objectives to complete using data from the completed grant: (1) Better define and describe this complex disease and how healing may happen using acupuncture, (2) Report on the best acupuncture protocols for GWI veterans and specific GWI symptoms so that we know which veterans and symptoms acupuncture works well for and how, (3) develop suggestions for how an acupuncture program may be implemented using the viewpoints of multiple stakeholders (including veterans). For the first two objectives we will use data from the parent project and a variety of statistical techniques. For the third objective we will use surveys of veterans and group meetings of veterans, medical doctors who work with military personnel and veterans, acupuncturists, and scientists to gather suggestions on how to make the best treatment program for veterans as soon as possible.

This project will offer information on which GWI veterans respond to acupuncture, how they respond, and how to implement a program that will help others find relief. Differences in how veterans respond to acupuncture treatment may help us understand how GWI works and help to find effective treatments for other veteran health concerns. This is important as use of Veterans Affairs health services has greatly increased by Persian Gulf-era veterans, and also returning Iraq/Afghanistan veterans, as well as Vietnam-era veterans. Acupuncture has the potential to be an effective, safe, low-cost treatment option which could be of help to all of these people.