Management of Chronic Multisymptom Illness: Synopsis of the 2021 US Department of Veterans Affairs and US DoD Clinical Practice Guideline 2022 Robbins

Full title: Management of Chronic Multisymptom Illness: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline

Abstract
In 2019, senior leaders within the US Department of Veterans Affairs and the US Department of Defense commissioned the update of a clinical practice guideline for managing chronic multisymptom illness. Clinical experts were assembled across both agencies to systematically review evidence and to develop treatment recommendations based on that evidence. This effort resulted in the development of 29 evidence-based recommendations for providing care for individuals with chronic multisymptom illness.

https://www.mayoclinicproceedings.org/article/S0025-6196(22)00065-9/fulltext

 

"Chronic multisymptom illness (CMI) is a condition characterized by multiple poorly understood symptoms not better accounted for by other behavioral or physical health conditions. For military personnel deployed during the Gulf War (1990-1991), CMI, termed Gulf War illness in this cohort, was highly prevalent and is considered the signature medical condition of this conflict.1 However, CMI is not unique to Gulf War veterans. The prevalence of CMI in veterans of modern wars is estimated to be between 25% and 49.5%,2,3 whereas population studies suggest that 26% to 35% of primary care patients present with a somatoform disorder and 40% to 49% have at least 1 medically unexplained physical symptom.4 Along with a decrease in quality of life, CMI imposes a significant burden of illness and disability for many service members and veterans as well as for nonmilitary patients."

 

"There is neither a unique International Classification of Diseases, Tenth Revision code for CMI nor a universally accepted clinical case definition and standardized terminology for CMI. The Institute of Medicine5
,6 (now the National Academy of Medicine) recognizes 2 case definitions for research purposes, the Centers for Disease Control and Prevention5 and Kansas6 definitions. Both case definitions require that patients have chronic symptoms from multiple body systems or domains, such as fatigue, mood/cognition, sleep, gastrointestinal, and pain.5,6 The case definitions for CMI overlap with other symptom-based conditions, including fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). There are relatively few clinical trials of treatments for CMI and fewer systematic reviews of evidence-based treatments, thus making it difficult for providers to effectively manage and treat patients with CMI.

The 2021 Department of Veterans Affairs/Department of Defense (VA/DoD) Clinical Practice Guideline (CPG) for the Management of CMI7
provides practitioners an evidence-based approach to assess, to care for, and to manage patients with CMI. Recommended categories of interventions include behavioral health, complementary and integrative health, and pharmacologic treatments.2 These interventions are summarized in Table 1. The CPG also provides guidance for delivering these treatments by a patient-centered approach including shared decision-making to set treatment goals as well as ensuring effective risk communication. The Figure, supported by additional information in Table 2, is an algorithm that was developed to assist clinicians in providing evidence-based, patient-centered care."

 

• 3.
  We suggest offering cognitive-behavioral therapy for CMI and symptoms consistent with fibromyalgia, irritable bowel syndrome, or myalgic encephalomyelitis/chronic fatigue syndrome.
• 4.
  We suggest offering mindfulness-based therapies for patients with CMI and symptoms consistent with fibromyalgia, irritable bowel syndrome, or myalgic encephalomyelitis/chronic fatigue syndrome.

 

You get a CBT course, you get a CBT course, you get a CBT course, you all get a CBT course!

 

The references for the CBT recommendations for ME/CFS are 1) one random review from 2015 that found the evidence is weak, and 2) a CBT trial for IBS and 2 BS open label generic "fatigue" trials by Knoop. All cherry-picked stuff with some random loopy algorithm.

Literally not bothering to put any effort into it. This is insulting in its lack of basic professionalism, and clearly the people involved in this have no stake in the matter and can't be bothered to pretend.

This isn't even what giving up looks like. This is what things look like when everyone has given up so long ago no one even remembers how to pretend to care.

 

You mean a MOA?

 

Then people that do that would be MOANERS?