The Institute of Medicine (IOM) recommends the U.S. Department of Veterans Affairs tailor treatment of veterans with chronic multisymptom illness to the needs of each patient, take a team approach to care, and employ the VA’s electronic health record to prompt caregivers to ask the right questions.

“There is no single therapy or universal treatment approach that will help all veterans experiencing chronic multisymptom illness (CMI),” an IOM committee wrote in a new report released Jan. 23. The IOM calls for customizing care with an array of therapies tailored to each former service member's needs.

VA should harness the potential of existing programs such as post-deployment patient-aligned care teams (PD-PACTS) to improve CMI care, the report added. The department should also pursue a new strategy of creating "CMI champions" to help its healthcare providers better serve patients with complex symptoms and needs, the committee said.

[See also: Telehealth extends care to veterans closer to home.]

To boost the department's ability to identify former service members with CMI, VA's electronic health record should prompt healthcare providers to ask patients about symptoms that characterize CMI. Veterans should undergo a comprehensive health examination immediately after they leave active duty, and the results of these exams should be available to clinicians both within and outside the VA health system to ensure continuity of care.

"Based on the voluminous evidence we reviewed, our committee cannot recommend using one universal therapy to manage the health of veterans with chronic multisymptom illness, and we reject a 'one size fits all' treatment approach," committee chair Bernard M. Rosof, chair, board of directors, Huntington Hospital, Huntington, N.Y., said in a news release. "Instead, we endorse individualized healthcare management plans as the best approach for treating this very real, highly diverse condition."

Written as part of IOM's congressionally mandated Gulf War and Health series, the report presents a comprehensive evaluation of the various treatments for CMI and recommends the best approaches to managing veterans' care. The committee defined CMI as the presence of a spectrum of chronic symptoms in at least two of six categories – fatigue, mood and cognition, musculoskeletal, gastrointestinal, respiratory and neurologic – experienced for at least six months. 

CMI shares characteristics with other conditions marked by chronic, medically unexplained symptoms, but its symptoms are not fully captured by other recognized syndromes, IOM notes. Formerly dubbed Gulf War Syndrome, CMI affects roughly one-third of veterans of the 1991 Persian Gulf War. Many personnel who served in the more recent conflicts in Iraq and Afghanistan have reported similar symptoms. In comparison, conditions involving chronic, unexplained symptoms affect roughly one-fourth of the general U.S. population. The cause or causes of CMI probably will never be fully determined, the committee said, but this does not undermine the legitimacy of veterans’ reports of symptoms.