Pain Relief (Morphine) and PTSD

[Eydawn]

MSNBC Article: Fast Morphine Treatment May Prevent PTSD

It seems that earlier administration of morphine, at least in this small study group, seemed to reduce the likelihood of injured soldiers developing PTSD. Though it needs more exploration, I think we should think about it in the EMS community... I know we always debate about when and how much pain relief to give, so with this new information to work with, would this potentially change your treatment practices?

They say in the article that it isn't known if it is the pain relief itself, or the inherent properties of morphine that lead to the reduced PTSD rates.

Just some food for thought...

Wendy

CO EMT-B

[JPINFV]

Beta blockers have been shown to prevent PTSD as well, however it's been decried by some (including the government) because of fear that preventing PTSD would also cause people to lose their memory. To the best of my knowledge, this concern hasn't been shown to actually happen.

[croaker260]

MSNBC Article: Fast Morphine Treatment May Prevent PTSD

It seems that earlier administration of morphine, at least in this small study group, seemed to reduce the likelihood of injured soldiers developing PTSD. Though it needs more exploration, I think we should think about it in the EMS community... I know we always debate about when and how much pain relief to give, so with this new information to work with, would this potentially change your treatment practices?

They say in the article that it isn't known if it is the pain relief itself, or the inherent properties of morphine that lead to the reduced PTSD rates.

Just some food for thought...

Wendy

CO EMT-B

I read this article, its a thought provoking one.

What is known...(or widely believed) that the sympathetic dump that occurs in traumatic situations, also known as epinepherine scarring, is a key component of PTSD. This is why techniques such as "stress innoculation" , intensive training, and "combat breathing"...all of which either help blunt the synpathetic response or stimulate the parasympathetic system....are believed to help in PTSD. (recomend "on Combat" by Dave grossman as interesting reading) It only makes sense that pain relief would be a part of this as well.

Beta Blockers woiuld also be an interesting study as well, though counterproductive in a traumatic injury situation.

Edited January 14, 2010 by croaker260

[under-dreaming]

Morphine not only reduces the sensation of pain, it causes an altered mental status. I would assume that it is this altered mental status that blocks out the traumatizing events. But to what degree does it block out the events? Does it just push the memories into the subconscious, waiting to emerge when some sort of object or event triggers them? Would hypnosis uncover the memories and anguish? It is an interesting thing to consider, but I am inclined to think that the memories would be getting stored in a different place.

It's like when someone is drugged before they are taken advantage of. They may not remember the event. They may not even be sure that it happened. But eventually the memory emerges (possibly many years down the road) and they are in need of intervention.

Traumatic things need to be faced and dealt with in a timely fashion. That is the prevention of PTSD.

[HERBIE1]

Well, if they are pushing the amnesiac effects, then I see problems with this. The conscious mind may not recall the trauma, but I would assume at some level, there is a stored memory that could resurface at any time. I read the article too and found it interesting.

Simply blunting the pain can't be the answer either, since many PTSD events aren't due to physical trauma or injuries.

We simply know so little about the brain and how we form memories, this is a tough subject.

[armymedic571]

I see several problems with this.

1. Many soldiers/marines with PTSD are already on multiple medications that they must self administer in austere environments. Initially, they (the military medical community) will try to treat these patients in theatre while many are still actively doing their jobs.

2. The addictive nature of morphine, combined with the fact that soldiers/marines are already at risk for substance abuse only raises more questions. Expecially in light that substance related suicides and serious incidence has risen dramatically over the last 5 years.

3. Having had first hand experiences with PTSD, medicated soldiers and the military medical community, I think knowing what the mechanism of action is before more trials are done is the most appropriate thing to do. This is for the safety of everyone concerned.

"Researchers have been testing ways to treat it, and the new study looked at whether fast and strong pain relief can help prevent it"

It sounds to me that some Navy MD is ust giving morphine to see what happens. Sounds crazy, but I have seen this happen.

Otherwise...This is interesting material. I just wish we weren't being used as test-rats.

[WolfmanHarris]

2. The addictive nature of morphine, combined with the fact that soldiers/marines are already at risk for substance abuse only raises more questions. Expecially in light that substance related suicides and serious incidence has risen dramatically over the last 5 years.

The addictive qualities of opiates continue to be overstated and lead to a continued reluctance to prescribe them when my understanding of the research is that in therapeutic doses physical and psychological dependence is limited. True as a population the risk of substance abuse in military personnel is higher, but I feel like the logistics of controlling and monitoring dosage while providing a potentially beneficial therapy is worth the effort vs. witholding a treatment based on a fear of substance abuse. I can't say this with any certainty as this is an area I have no experience in. I just find the withholding of pain medication of fears of addiction a little backwards.

I agree with the rest of your point though.

Cheers,

- Matt

Edit: I can't recall the reading/research my assertions are based on. So before I'm asked to back them up I'm heading to PubMed now to see what I can find one way or the other. I suppose I could be wrong. It's been known to happen. Just don't tell my fiance.

Edit 2: Read through the article again. Without having the original study I can't be sure, but it sounds like the results were in pt.'s already receiving morphine in short order after being wounded for their injuries, not as part of their later rehab or psychological care. If anything the implication seems to be that pain needs to be managed more aggressively when the wounded pt. reaches definitive care to help limit the long-term complication of PTSD. In which case we're not talking about taking traumatized Soldiers, Sailors, Airmen or Marines and giving them a bottle of vicodin to take into the field or the like, only they care they're recieving immediately following their injury.

Edited January 15, 2010 by docharris

[maverick56]

Hmmm, very interesting, especially having experience in all these areas. I'll have to read it over and come back to the board tomorrow. Unfortunately, I need to get to bed right now, but I'm sure I'll have thoughts on the subject later.

[Richard B the EMT]

Some of you might recall, in 2005, I had emergency surgery for an aneurysm (or "pseudo-aneurysm") in my right femoral artery, following a cardiac angiogram/angioplasty. For my personal fear of becoming an addict from any doses of Morphine, despite the "11 on a scale of 10" pain I was in, I put off for about 2 hours, getting what would be my one and only dose of the stuff.

I never even felt any effect from the Morphine dose, up until the surgical staff put me "under" for the corrective surgery.

Just mentioning this, as a "first hand" of using Morphine.

Edited January 15, 2010 by Richard B the EMT