A 2013 report by the Institute of Medicine reviewed the peer-reviewed published medical literature for evidence regarding treatments for symptoms associated with chronic multisymptom illness (CMI) in 1990–91<unk> <unk>  veterans, and in other chronic multisymptom conditions. For the studies the report reviewed that were specifically regarding CMI in 1990–91<unk> <unk>  veterans <unk> <unk>  illness), the report made the following conclusions: * Doxycycline: "Although the study of doxycycline was found to have high strength of evidence and was conducted in a group of 1991<unk> <unk>  veterans who had CMI, it did not demonstrate efficacy; that is, doxycycline did not reduce or eliminate the symptoms of CMI in the study population." * Cognitive Behavioral Therapy (CBT) and Exercise: "These studies evaluated the effects of exercise and CBT in combination and individually. The therapeutic benefit of exercise was unclear in those studies. Group CBT rather than exercise may confer the main therapeutic benefit with respect to physical symptoms." The report concluded: "On the basis of the evidence reviewed, the committee cannot recommend any specific therapy as a set treatment for<unk> <unk>  veterans who have CMI. The committee believes that a 'one-size-fits-all' approach is not effective for managing<unk> <unk>  veterans who have CMI and that individualized health care management plans are necessary." By contrast, the U.S. Department of Defense (DoD) noted in a May 2018 publication that the primary focus of its<unk> <unk>  illness Research Program (GWIRP) "has been to fund research studies to identify treatment targets and test interventional approaches to alleviate symptoms. While most of these studies remain in progress, several have already shown varying levels of promise as GWI treatments." According to the May 2018 DoD publication: Published Results on Treatments The earliest federally funded multi-center clinical trials were VA- and DoD-funded trials that focused on antibiotic treatment (doxycycline) (Donta, 2004) and cognitive behavioral therapy with exercise (Donta, 2003). Neither intervention provided long-lasting improvement for a substantial number of Veterans. Preliminary analysis from a placebo-controlled trial showed that 100 mg of Coenzyme Q10 (known as CoQ10 or Ubiquinone) significantly improved general self-reported health and physical functioning, including among 20 symptoms, each of which was present in at least half of the study participants, with the exception of sleep. These improvements included reducing commonly reported symptoms of fatigue, dysphoric mood, and pain (Golomb, 2014). These results are currently being expanded in a GWIRP-funded trial of a "mitochondrial cocktail" for GWI of CoQ10 plus a number of nutrients chosen to support cellular energy production and defend against oxidative stress. The treatment is also being investigated in a larger, VA- sponsored Phase III trial of Ubiquinol, the reduced form of CoQ10. In a randomized, sham-controlled VA-funded trial of a nasal CPAP mask (Amin, 2011-b), symptomatic GW Veterans with sleep-disordered breathing receiving the CPAP therapy showed significant improvements in fatigue scores, cognitive function, sleep quality, and measures of physical and mental health (Amin, 2011a). Preliminary data from a GWIRP-funded acupuncture treatment study showed that Veterans reported significant reductions in pain and both primary and secondary health complaints, with results being more positive in the bi-weekly versus weekly treatment group (Conboy, 2012). Current studies funded by the GWIRP and the VA are also investigating yoga as a treatment for GWI. An amino acid supplement containing L-carnosine was found to reduce irritable bowel syndrome-associated diarrhea in a randomized, controlled GWIRP-funded trial in GW Veterans (Baraniuk, 2013). Veterans receiving L-carnosine showed a significant improvement in performance in a cognitive task, but no improvement in fatigue, pain, hyperalgesia, or activity levels. Results from a 26 week GWIRP-funded trial comparing standard care to nasal irrigation with either saline or a xylitol solution revealed that both irrigation protocols reduced GWI respiratory (chronic rhinosinusitis) and fatigue symptoms (Hayer, 2015). Administration of the glucocorticoid receptor antagonist mifepristone to GW Veterans in a GWIRP-funded randomized trial resulted in an improvement in verbal learning, but no improvement in self-reported physical health or other self-reported measures of mental health (Golier, 2016).Ongoing Intervention Studies The GWIRP is currently funding many early-phase clinical trials aimed at GWI. Interventions include direct electrical nerve stimulation, repurposing FDA-approved pharmaceuticals, and dietary protocols and/or nutraceuticals. Both ongoing and closed GWIRP-supported clinical treatment trials and pilot studies can be found at . A Clinical Consortium Award was offered in FY2017 to support a group of institutions, coordinated through an Operations Center that will conceive, design, develop, and conduct collaborative Phase I and II clinical evaluations of promising therapeutic agents for the management or treatment of GWI. These mechanisms were designed to build on the achievements of the previously established consortia and to further promote collaboration and resource sharing. The U.S Congress has made significant and continuing investment in DoD's<unk> <unk>  illness treatment research, with $129 million appropriated for the GWIRP between federal fiscal years (FY) 2006 and 2016. The funding has risen from $5 million in FY2006, to $20 million each year from FY2013 through FY2017, and to $21 million for FY2018.
Gulf War syndrome
SAHA syndrome
Toxic shock syndrome
Primrose syndrome
Proteus syndrome
Systemic inflammatory response syndrome
SUNCT syndrome
Severe fever with thrombocytopenia syndrome