NEJM study finds post-event morphine cuts combat PTSD rates in half

This is a pretty big deal if it holds up in future trials. One caveat I've not had time to check out is whether the morphine was often applied as part of an more robust medical response in general, which itself might reduce later PTSD symptoms. I hope the DOD soon follows up with another, larger study, for as Ben Carey notes, the has some substantial implications if indeed it holds up.

In the new study, researchers at the Naval Health Research Center in San Diego reviewed detailed medical records of 696 troops who had been wounded in Iraq between 2004 and 2006, determining whether and when morphine was used in treatment. Military doctors used the drug for most serious injuries -- generally in the first two hours after the injury -- but sometimes administered others, like anti-anxiety medications

The study found that 243 of the servicemen and women were given a
diagnosis of post-traumatic stress within two years of their injury.
When the severity of the wounds was taken into account, researchers
calculated that the diagnosis was half as common in those who had
received morphine as in those who had not.

Age, sex and the
cause of injury did not significantly alter the findings, said Troy
Lisa Holbrook, the study's lead author.

"This is just one paper,
one analysis, but it's exciting because of the strength of the
finding," Dr. Holbrook said. "A lot of people have been looking for a
secondary preventive to interrupt the formation of traumatic memories."

...The drugs appear to blunt the emotional charge of traumatic memories
in several ways. Most obviously, they kill the pain when it is most
excruciating; often, they scramble the ability to recall what exactly
happened. Opiates also inhibit the production of a chemical messenger
called norepinephrine, which is thought to enhance fear signals in the brain.

Posted via web from David Dobbs's Somatic Marker

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However, there is an ethical problem with this - what if they need to testify about it in, say, a war crime trial?

Also, why interrupt the formation of memories?

Does the military not have enough resources to provide counseling sessions to all soldiers when they get back?

By Katharine (not verified) on 14 Jan 2010 #permalink

Morphine may reduce PTSD rates...but what about the potential for increasing rates of morphine addiction?

Interrupting the formation of traumatic memories doesn't mean interrupting the formation of memories, period. Being severely traumatized can actually affect the formation of memories, for instance even causing blackouts. Being in the brain-state that we call trauma is damaging to the brain in a physical sense.

If opiates can prevent the link between a particular memory and the extreme debilitating fear reaction that constitutes PTSD, I'd say that's worth it. It could make it easier for them to testify at trial: if they can remember things without feeling traumatized or having a flashback they'd probably have an easier time remembering more objective details about the event, not to mention being able to testify about it.

I have seen a number of people getting morphine IV for serious ski injuries. None of them have said it "kills the pain", and there isn't any loss of memory of the event in the doses we use.

They all agree that it "takes the edge off" the pain, and they are strikingly less anxious and fearful than they were before the morphine. I know part of that is the pain relief, but there seems to be an emotional relief too.

@2 - The incidence of addiction when it is used for short-term relief of injuries is very low.

By Tsu Dho Nimh (not verified) on 14 Jan 2010 #permalink

Personally, I'd not consider someone with PTSD a very convincing witness, especially not years after the event (and the lag in war-crimes trials is normally that bad). Eyewitnesses in general are not the most reliable of sources of evidence. Also, counselling people to help them recover from or manage PTSD seems very inferior ethically than treating them to stop the disease developing in the first place (almost on a par with saying you'll abandon preventative for palliative medicine for infectious disease or cancer).

By stripey_cat (not verified) on 14 Jan 2010 #permalink

Stripey - it's not eye-witness accounts. It's the difference in the amount of diagnoses for PTSD, one group who received morphine being the ones with a statistically significant trend toward not being diagnosed.

Tsu: Ski injuries are trauma, may even lead to PTSD for sure, but I don't think only the memory loss that's key to preventing it rather the minor 'sensation' loss immediately afterward.

As a PTSD survivor I would have loved to have not been subjected to any prolongation of the fear, misery, shock, depression, guilt etc. that went along with my event. All I got was Tylenol with codeine. If only I'd had sweet, sweet morphine!

As for robbing me of my memories, please do.

People with PTSD receive financial compensation and other benefits from the US Govt. long term as well as status as a wounded veteran. People with serious trauma, i.e. the sort treated by morphine near the time of injury, also receive financial compensation and other benefits from the US Govt. long term as well as status as a wounded veteran.

How can we tell if the lower PTSD rates in the morphine treated group are not simply due to that group having less financial incentive to claim PTSD since they are already gaining US Govt. benefits and status due to their injuries?

By Nerissa Belcher (not verified) on 15 Jan 2010 #permalink

#1 - Katharine, your comment is dripping with insensitivity, lack of understanding, and perhaps just a tiny bit of dislike of things military.

First, would it be unethical to treat the injuries of a rape victim, just in case she needed to testify about it later?

Second, should that rape victim be denied pain-killers because they might blunt the formation of highly accurate memories that will stay "fresh" in her mind, possibly causing her to "relive" the incident over and over for years to come?

Third, why do you assume all soldiers need counseling when they get back?