Predictors of incident chronic widespread pain among veterans following the first Gulf War.
OBJECTIVE
We sought to determine the predictors of incident chronic widespread pain (CWP), specifically, the effect of preexisting symptoms, stress, and psychosocial factors in the subsequent development of CWP among veterans from the first Gulf War (GW).


METHODS
We conducted a structured telephone survey (baseline) of military personnel originally from Iowa who were either eligible for or deployed to Operation Desert Shield/Desert Storm, approximately 5 years postconflict. We conducted a follow-up, clinical, in-person study of those who met a priori-defined outcomes of symptoms of cognitive dysfunction, depression, or CWP, and also a sample of those who did not meet any of the outcomes of interest.


RESULTS
A total of 370 of 602 evaluated GW veterans were free of CWP 5 years postconflict. At follow-up, 69 (19%) of these had developed CWP. A positive family history of medically unexplained persistent symptoms [odds ratio (OR)=4.8 (2.3, 13.2)] was strongly associated with CWP. At baseline, individuals who reported preexisting symptoms of bronchitis [OR=4.9 (1.9, 12.3)] and cognitive dysfunction [OR=2.1 (1.1, 4.2)] were more likely to develop CWP. Alcohol use [OR=0.2 (0.1, 0.7)] was protective against CWP. Rather than combat-related exposure per se, the perception of stress at the time of the GW [OR=1.6 (1.1, 2.3)] correlated with CWP.


CONCLUSIONS
Among the GW veterans evaluated longitudinally in this study, family history, predeployment symptoms, and the level of perceived stress during the GW were associated with subsequent development of CWP.
Ang
Dennis C
DC
Division of Rheumatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. dang@iupui.edu
Peloso
Paul M
PM
Woolson
Robert F
RF
Kroenke
Kurt
K
Doebbeling
Bradley N
BN
D000328:Adult; D002908:Chronic Disease; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D047830:Gulf War; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods; D018923:Persian Gulf Syndrome / Q000150:complications* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology*