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Health and Human Services Department of Defense Veterans Affairs Health and Human Services Gulf War Information Department of Defense Gulf War Information Veterans Affairs Gulf War Information Home Home Advanced Search Glossary FAQs Site Map Contact Us
 Research Topics    |    Major Focus Areas
Research Topics
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General
Project Summary

Title: Mechanisms in Chronic Multisymptom Illnesses
Synopsis: The goal of this study is to determine the mechanisms of three prominent symptoms (pain, fatigue, and memory difficulty) associated with Fibromyalgia, Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, and illnesses of Gulf War veterans.
Overall Project Objective: 1) To determine the mechanisms responsible for 3 prominent symptoms (pain, fatigue, and memory difficulties) of Fibromyalgia (FMS), Chronic Fatigue Syndrome (CFS), Multiple Chemical Sensitivity (MCS), and Gulf War Illnesses (GWI); 2) to determine whether an established non-pharamacological intervention (Cognitive Behavioral Therapy) is effective when administered using internet and telemedicine techniques.
Status/Results to Date: To date 33 FMS subjects, 4 CFS subjects, 6 Ill Gulf War subjects and 26 healthy sedentary control subjects have been studied. Completion of data collection on this part of the CMI project was targeted for April 2001. The web and telemedicine applications were developed for the CBT trial and are in the testing phase. IRB approvals have been received from Georgetown and Avera-McKennan. The target start-up date for the first study is February 2002.
Project:DoD-101
Agency:Department Of Defense
Location:Georgetown University
P.I. Name:Daniel Clauw, M.D.
Research Type:Clinical
Research Focus:Brain & Nervous System
Focus Category:General Health & Physical Symptoms
Status:Ongoing
Study Start Date:January 31,2000
Estimated Completion Date:August 31,2001
Specific Aims: See objective.
Methodology: This is a multi-disciplinary study. Using matched case-controls, the testing protocols examine: aberrant afferent sensory stimuli processing, abnormal cortical and sub-cortical CNS function, and disturbances of efferent neurohormonal function to include the autonomic nervous system and hypothalamic-pituitary axis. Approximately 240 subjects will be studied. Initial recruitment of non-control subjects will involve enrolling subjects who satisfy the working case-criteria for Chronic Multisymptom Illness proposed by Fukuda, et al (1998). All subjects will be thoroughly medically evaluated and further subclassification of subjects will be made based on the presence of a diagnosis of fibromyalgia, chronic fatigue syndrome, Gulf War veterans' illness, and multiple chemical sensitivity. In addition to healthy, sedentary control subjects, there will be at least two positive controls: 1) individuals with a diagnosis of depression, and 2) healthy, asymptomatic Gulf War veterans. Subjects will be brought into Georgetown's NIH General Clinical Research Center for 1-1/2 to 2-1/2 days. During their stay they will undergo a variety of tests to determine the responses of the HPA axis, the autonomic nervous system, and sensory nociception. Physiological and biochemical endpoints will be collected. The stressors include exercise stress, cognitive stress, and pain stress. New to this study, is the use of fMRI to examine regional brain blood flow in response to stressors. A highly regarded scientific team responsible for specific portions of the project is committed, by affirmation letter, to participation. In April of 2001, additional funds were added to this cooperative agreement for additional research on Gulf War veterans' illnesses and Chronic Multisymptom Illnesses along with a second research component directed towards research on non-pharmacologic treatment interventions for persons with CMI. The second component is being pursued with the Avera-McKennan Health Care System located in Sioux Falls, SD. This project is designed to test the efficacy and efficiency of delivery of cognitive behavioral therapy (CBT) to persons with CMI using telemedicine and internet approaches. These approaches could have enormous impact on how active-duty servicemembers may receive healthcare for chronic symptom-based conditions that may affect as many as 14% of active duty personnel. Technology development for this project has moved apace and we are on track to begin pilot studies in South Dakota by February 2002.
Most Recent Publications:

Petzke F, Khine A, Williams D, Groner K, Clauw D, Gracely R. Dolorimetry performed at three paired tender points highly predicts overall tenderness. J Rheumatol, 28(11):2568-9, Nov 2001. Article

Stein PK, Domitrovich PP, Ambrose K, Lyden A, Gerrity TR, Clauw D. Female fibromyalgia patients have abnormal autonomic function assessed by time domain, frequency domain and non-linear heart rate variability analysis. N/A, Submitted. Article

Gracely R, Petzke F, Wolfe J, Clauw D. Functional MRI Evidence for Augmented Pain Processing in Fibromyalgia. N/A, Submitted, 28 (11): 25, 68-69, Nov 2001. Article

Williams D, Cary MA, Chaplin W, Glazer L, Rodriguez A, Clauw D. Improving physical functional status in patients with fibromyalgia: a brief cognitive behavorial intervention. N/A, Submitted. Article

Farrell MJ, Cunningham J, Ambrose K, Sinkfeld D, Clauw D. Knee pain and radiographic osteoarthritis interact in the prediction of levels of self-reported disability. N/A, Submitted. Article

Clauw D, Barkhauzen A, Engel CC, Donta ST, Williams D, Kazis LE, Sogg S, Guarino G, Peduzzi P, Skinner JS, Feussner JR. Measurement of tenderness in Gulf War veterans: what does it tell us? Arthritis Rheum, 44 (9 Suppl), Sep 2001. Article

Petzke F, Gracely R, Park KM, Ambrose K, Clauw D. What do tender points measure? Influence of distress on 4 measures of tenderness. Journal of Clinical Rheumatology, 30(3):567-574. Mar 2003. Abstract