From USA Today, 21 March 2013 (story by Kelly Kennedy).
WASHINGTON — Researchers say they have found physical proof that Gulf War illness is caused by damage to the brain — and that proof may ultimately help civilians who suffer from chronic fatigue syndrome and fibromyalgia.
Using fMRI machines, the Georgetown University researchers were able to see anomalies in the bundle of nerve fibers that interpret pain signals in the brain in 31 Gulf War veterans. The research will be published Wednesday in PLOS ONE journal.
The findings are “huge,” because an fMRI allows doctors to diagnose a person with Gulf War illness quickly, said James Baraniuk, senior author and professor of medicine at Georgetown University Medical Center. The research, he said, also shows that Gulf War illness is not psychological.
An fMRI, or “functional” MRI, is a scan that measures activity by detecting how blood flows through the brain.
Many veterans have had difficulties getting benefits and treatment for a service-connected condition because doctors assumed they were either faking it or suffering from post-traumatic stress. “That's a problem with all physicians — VA, military or civilian,” Baraniuk said. “If it doesn't fall within their small world of known diseases, then the patient is nuts.”
Gulf War illness is a series of symptoms that has affected more than 250,000 veterans of the 1991 war against Iraq in response to Iraq's invasion of Kuwait.
Baraniuk said the correlation of anomalies in the brain's white matter with Gulf War illness has not been studied before. Researchers, he said, also found that fatigue and pain worsen congruently in the veterans.
To test the veterans, they watched the way liquid moved through brain nerve cells at rest and while the veterans were exercising. They could locate the nerves' axons and determine how healthy they were, said Rakib Rayhan, lead author of the study.
“We're able to say, ‘There is something here,' ” Rayhan said. ” ‘Take these veterans seriously when they come in.' ”
In particular, John VanMeter, director of Georgetown's Center for functional and molecular imaging, said they looked at the fibers that process pain.
“The fibers in the Gulf War veterans have deteriorated compared to the control,” he said. Those fibers interpret environmental pain, but in the case of the veterans, a tiny pulse of pressure is interpreted as a painful pinch, or normal muscle fatigue from walking a flight of stairs could be interpreted as climbing to the fourteenth floor. “They get, ‘I'm in pain! I'm in pain! I'm in pain!' all the time.”
He said that most hospitals already have the MRI equipment they need to do the exam, but they may need to purchase or install fMRI software, as well as to be trained to use it.
The researchers do not know whether the veterans' symptoms will continue to worsen, though it appears they have from their onset 22 years ago until now.
“The guys who were robust and leading the charge on this 10 years ago are now using canes,” Baraniuk said.
This research appears to correlate with previous research on Gulf War Illness, including a major study this year that showed problems in involuntary function, and a second that showed that as many as 100,000 troops may have been doused with Sarin gas when the U.S. Air Force bombed a munitions factory during the war.
The researchers suspect the damage came from environmental factors. Other researchers have found that as many as 100,000 troops were exposed to Sarin gas when the U.S. Air Force bombed an Iraqi munitions plant, and other researchers have found a connection between the symptoms and the ACHL-inhibitors found in nerve agents, the anti-nerve-agent pills servicemembers took, and the industrial-strength bug spray troops used on their clothing and skin.
Baraniuk believes that the three areas of symptoms seen in Gulf War veterans are all different stages of the same disease — and he will be able to show that in a future paper.
Veterans who participated in the study said the illness has hurt them but they were optimistic about the survey's findings.
Army veteran Robert Ward's symptoms began while he was still in the Middle East. He felt tired and his gums started to swell and bleed. He figured it was a fluke, until he read a newspaper article in 1993 and discovered he was one of many. Soon, he suffered irritable bowel syndrome, constant headaches, muscle twitches, rashes and muscle fatigue. For 18 months, he found himself bedridden. He moved in with his parents so they could help care for him.
“This is a big deal,” he said. “This has ruined my life. I'm thankful that Gulf War illness patients will be able to get the help that they deserve.”
Denise Nichols, an Air Force veteran, also had symptoms while she was still in the Middle East, including irritability, hair lossand sensitivity to light and noise. When she came home, she had blurred vision and tight muscles.
“I quit nursing because I was afraid of making errors or exposing patients to whatever I had,” she said. When she learned the results of the study, she yelled, “Yes! Yes! Yes! We're finding real proof.”
Still, she said, it's bittersweet to wait 22 years.
The researchers themselves said they've been surprised by how little attention this group of veterans has received.
“If 30% of Congress got sick, or 30% of Manhattan got sick, there would have been an outcry,” Baraniuk said.
That’s fascinating, and very good to know that they’re finding firm organic evidence of brain/nerve damage in Gulf War Syndrome! Hopefully this will start to shift doctors’ opinions in the UK, too.
However, there’s something about the way they describe it as magnifying pain perception that bothers me. I think it’s the phrase, “a tiny pulse of pressure is interpreted as a painful pinch, or normal muscle fatigue from walking a flight of stairs could be interpreted as climbing to the fourteenth floor.” I wonder if that phrasing might lead some GPs to write off GWS in a whole new and different way, as something organic, yes, but still ultimately an oversensitivity to normal stimuli, and all you need to do to fix it is retrain your pain threshold! And yet again, CBT will be the much-touted answer. D:
In addition, if we follow through and assume (for the sake of argument) a similar mechanism for ME, then if I’m understanding correctly, if patients’ brains are misinterpreting “normal” stimuli and magnifying it, you would expect their overall pain thresholds to be lower and their response to all normal stimuli to be equally overblown. I don’t know about anyone else, but that certainly isn’t true for me; I have a strangely persistent set of veruccae, and my chiropodist has mentioned more than once that I have one of the highest pain thresholds she’s seen. Surely that’s inconsistent with the idea that I’m suffering post-exertional pain/weakness/etc because my brain is misinterpreting a normal amount of lactic acid build-up.
There are certainly some areas where I’d say yes, my brain’s sensory editing process is faulty – hyperacusis, light sensitivity, vocabulary recall and understanding other people’s speech, to name a few – but my general perception of pain outside of specifically ME symptoms (e.g. cryotherapy, cut fingers, headaches) is exactly the same as it always was. Consequently, if there’s visible damage to the areas of the brain that register pain perception, I’d be more inclined to wonder if it’s not the cause of the problem so much as simply the result of long term exposure to high pain levels.