Post-deployment Pain: A Need for Rapid Detection and Intervention

Pain, typically of musculoskeletal or unexplained origin, was one of the most common symptoms reported by military personnel deployed to the Persian Gulf prior, during, and following the 1991 Gulf War [1]. Despite the brief duration of armed conflict and the limited number of casualties, almost 15% of US Persian Gulf War (PGW) veterans have pursued treatment for Gulf War-related problems [2]. High rates of symptom clusters similar to those reported by US troops have been observed in UK [3] and Dutch [4] military returnees as well. Concerns over the prevalence of pain and other health complaints among PGW deployees led to several large-scale epidemiologic and interventional studies designed to identify symptom clusters, risk factors, potential etiologic agents, and intervention outcomes. Although the meaningfulness and associated etiology of the identified multisymptom illness clusters, which include pain, remain in dispute [2,5], evidence for the efficacy of cognitive behavioral and multidisciplinary treatment of this constellation of complaints (also termed Medically Unexplained Symptoms or MUS) has been reported [6]. Subsequently, clinical practice guidelines for MUS diagnosis and treatment were developed (http://www.oqp.med.va.gov/cpg/cpgn/mus/mus_base.htm) as a resource for practitioners.