5.6
Neuropathic Symptoms
5.6.1
Neuropathic symptoms at follow up
From a list of 17 neuropathic symptoms, Figure 1 and Table 1 show the number and type of
neuropathic symptoms which participants reported having experienced in the month prior to
follow up. The mean number of reported symptoms was similar in the two groups.
Approximately 60% of Gulf War veterans and 52% of the comparison group reported at least
one neuropathic symptom in the previous month, and approximately 24% and 18%,
respectively, reported at least four neuropathic symptoms. These differences between
groups were statistically significant. Gulf War veterans were also significantly more likely to
report one or more symptom of muscle weakness and marginally significantly more likely to
report at least one symptom of sensory disturbance. Specific symptoms which were
reported significantly more frequently by Gulf War veterans were ‘difficulty lifting objects
above the head’, ‘difficulty getting up from sitting in a chair’, ‘problems with feet tripping or
feet slapping when walking’, ‘difficulty feeling pain, cuts or injuries’ and ‘unusual sensitivity or
tenderness of your skin when rubbed by clothes or bedclothes’.
Figure 1 Number of neuropathic symptoms reported at follow up
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Table 1 Number and type of neuropathic symptoms at follow up
Gulf War
veterans
N=686
Comparison
group
N=651
Mean (sd)
Mean (sd)
Ratio of
means*
Adj ratio of
means†
2.2 (3.0)
1.7 (2.5)
1.21
1.14 (0.96 – 1.36)
n (%)
n (%)
RR
Adj RR (95% CI)b
One or more
409 (59.62)
339 (52.07)
1.14
1.13 (1.03-1.25)
Four or more
164 (23.91)
114 (17.51)
1.37
1.32 (1.07-1.64)
One or more symptom of muscle weakness
307 (44.05)
234 (35.51)
1.24
1.23 (1.08-1.41)
Difficulty lifting objects above head
161 (23.10)
105 (15.93)
1.45
1.42 (1.13-1.79)
Difficulty undoing buttons
45 (6.46)
29 (4.40)
1.47
1.38 (0.86-2.20)
Difficulty turning doorknobs/unscrewing jars
68 (9.78)
48 (7.32)
1.34
1.28 (0.89-1.83)
234 (33.77)
179 (27.37)
1.23
1.25 (1.06-1.48)
Problems with tripping or feet slapping while
walking
48 (9.60)
20 (3.05)
1.62
1.54 (1.07-2.22)
Difficulty swallowing food (more than
occasionally)
25 (3.59)
15 (2.29)
1.57
1.65 (0.83-3.28)
316 (45.34)
259 (39.30)
1.15
1.14 (>1.00-1.29)
Difficulty recognising hot from cold water
11 (1.58)
2 (0.31)
5.18
4.59 (0.96-21.91)
Difficulty feeling pain, cuts or injuries
33 (4.74)
9 (1.37)
3.45
3.25 (1.45-7.30)
Numbness, “asleep feeling” or prickling
sensation in hands or arms
198 (28.49)
156 (23.85)
1.19
1.14 (0.95-1.37)
Numbness, “asleep feeling” or prickling
sensation in feet or legs
160 (23.02)
129 (19.69)
1.17
1.13 (0.92-1.39)
Burning, deep aching pain or tenderness in
hands or arms
76 (10.95)
55 (8.40)
1.30
1.19 (0.85-1.66)
Burning, deep aching pain or tenderness in
feet or legs
103 (14.80)
91 (13.89)
1.07
1.02 (0.78-1.34)
Unusual sensitivity or tenderness of your skin
when clothes or bedclothes rub against you
48 (6.90)
20 (3.05)
2.26
2.07 (1.23-3.46)
Feeling unsteady walking on even ground
83 (11.93)
65 (9.92)
1.20
1.18 (0.87-1.61)
Feeling unsteady walking in the dark
75 (10.79)
57 (8.70)
1.24
1.16 (0.83-1.63)
Feeling like you might fall over because of
unsteadiness
60 (8.62)
42 (6.42)
1.34
1.18 (0.80-1.73)
97 (13.94)
64 (9.77)
1.43
1.34 (0.99-1.83)
Number of neuropathic symptoms
Symptoms of muscle weakness
Difficulty getting up from sitting in a chair
Symptoms of sensory disturbance
One or more symptom of sensory disturbance
Symptom of autonomic dysfunction
Feeling faint when standing up from lying or
sitting
* Obtained using zero-inflated negative binomial regression
† Adjusted for age (<20; 20-24; 25-34; >=35 years), service branch (Navy; Army; Air Force) and rank (CO, NCO, enlisted
ranks), each estimated as at August 1990, and alcohol (AUDIT score > 10) and self-reported doctor-diagnosed diabetes
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5.6.2
Association between Gulf War deployment characteristics
and neuropathic symptoms in veterans at follow up
Table 2 shows that, relative to Officers, Gulf War veterans who served under the two lower
rank categories; ‘other rank supervisory’ and ‘other rank-non supervisory’; reported a
significantly higher average number of neuropathic symptoms at follow up. There was no
association between average number of neuropathic symptoms reported at follow up and
service branch or age category during the Gulf War.
Table 2 Association between Gulf War deployment characteristics and average
number of neuropathic symptoms at follow up in Gulf War veterans
Gulf War deployment
characteristic
Total number of neuropathic symptoms at follow up in
Gulf War veterans
N
mean (SD)
ratio
Adj ratio* (95% CI)
Age at deployment
< 20
62
2.5 (3.4)
1.00
1.00
20-24
166
2.0 (3.6)
0.87
0.93 (0.61 – 1.44)
25-34
358
2.2 (3.0)
0.87
0.95 (0.61 – 1.50)
>=35
100
2.5 (2.6)
0.77
0.96 (0.57 – 1.61)
Navy
589
2.2 (3.0)
1.00
1.00
Army
46
2.8 (3.5)
1.15
1.19 (0.79 – 1.77)
Air Force
51
1.6 (2.1)
0.77
1.00 (0.64 – 1.56)
Officer
147
1.4 (2.4)
1.00
1.00
Other rank-supervisory
348
2.3 (3.0)
1.38
1.50 (1.07 – 2.11)
Other rank - non supervisory
190
2.6 (3.2)
1.50
1.64 (1.07 – 2.51)
Service branch
Rank category
*Adjusted for age (<20; 20-24; 25-34; >=35 years), service branch (Navy; Army; Air Force) and rank (CO, NCO, enlisted ranks),
each estimated as at August 1990, alcohol (AUDIT score > 10) and self-reported doctor-diagnosed diabetes
5.6.3
Key findings
The mean number of neuropathic symptoms in the previous month, reported by both study
groups, was approximately two of the 17 symptoms measured. Gulf War veterans were
significantly more likely than the comparison group to report at least one neuropathic
symptom (60% vs 52%), or at least four neuropathic symptoms (24% vs 18%), one or more
symptom of muscle weakness (44% vs 36%) and one or more symptom of sensory
disturbance (45% vs 39%). Individual symptoms which were reported significantly more
frequently by Gulf War veterans were ‘difficulty lifting objects above the head’, ‘difficulty
getting up from sitting in a chair’, ‘problems with feet tripping or feet slapping when walking’,
‘difficulty feeling pain cuts or injuries’ and ‘unusual sensitivity or tenderness of your skin
when rubbed by clothes or bedclothes’.
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In Gulf War veterans, increasing number of neuropathic symptoms reported at follow up was
associated with lower rank category during the Gulf War, but it was not associated with
service branch or age category during the Gulf War.
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