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Appendix B: Possible Factors Underlying Chronic Multisymptom Illness
Pages 203-206

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From page 203...
... That mechanism is similar to the current understanding of IBS in deployed Gulf War veterans, which appears to develop by the combination of gastroenteritis, leading to gut mucosal immune dysfunction and inflammation, and impairment of the brain's ability to reduce or downregulate neural signals from the gastrointestinal tract related to the deployment experience (Drossman, 1999; IOM, 2010; Spiller and Garsed, 2009)
From page 204...
... . In addition, peripheral inflammatory states associated with increased cytokine activation may in turn alter brain functioning, producing "sickness behavior." These phenomena may help to explain the emotional distress and increased symptom awareness associated with CMI (Dantzer et al., 2008)
From page 205...
... In CMI, central factors may lead to a lower sensation threshold and, if this is the case, centrally targeted treatments would probably have therapeutic value by increasing sensation thresholds, as occurs in treatment for other conditions, such as fibromyalgia, CFS, and IBS. There is some evidence that patients who have similar somatic symptoms have higher concentrations of substance P (which transmits pain)
From page 206...
... 2008. E ­ ffect of abuse history on pain reports and brain responses to aversive visceral stimula tion: An FMRI study.

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