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Morphine and PTSD Risk in Injured Combat Veterans

Early use of morphine seems to protect against the later development of the disorder.

An improved understanding of the pathophysiology of post-traumatic stress disorder has prompted researchers to explore the use of medication (e.g., beta blockers) for the secondary prevention of PTSD in traumatized and injured individuals.

These investigators used administrative data to examine whether morphine given during resuscitation or trauma care to injured U.S. military personnel affects the subsequent development of PTSD. Medical encounter forms and clinical records concerning 696 injured soldiers without serious traumatic brain injury were linked with assessments for PTSD made at military or private treatment facilities. These assessments occurred from 1 to 24 months after the injury; 243 soldiers received new PTSD diagnoses.

After controlling for injury severity, amputation, mild traumatic brain injury, and Glasgow Coma Scale score, the researchers found that receipt of morphine protected against the development of PTSD. Depending on the model used, odds ratios ranged from 0.49 to 0.67. The effects were not dependent on morphine dose.

Comment: In earlier studies, morphine was associated with less-severe PTSD symptoms in civilian victims of motor vehicle accidents and protected against the development of PTSD in child burn victims. The current findings are consistent with neurobiological data implicating increased noradrenergic activity in the potentiation of fear memories, because opiates interfere with or prevent memory consolidation in animal models of conditioned fear. How morphine is protective remains unclear: Is the effect entirely due to morphine's influence on the consolidation of fear memories, or does reduction in pain mediate the opiate's effect — and if so, to what degree?

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry January 13, 2010

Citation(s):

Holbrook TL et al. Morphine use after combat injury in Iraq and post-traumatic stress disorder. N Engl J Med 2010 Jan 14; 362:110.

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• ptsd
  m r mccutcheon, 14 Jan 2010 10:16 AM EST
  wonder what effect versed or valium would have is used along with morphine?
• Morphine and PTSD prevention
  Kristine M. Campbell MD, 14 Jan 2010 11:14 AM EST
  Interesting. A study of morphine's effects on PTSD development in victims of other trauma, including psychological trauma could be helpful... [more]
• Morphine & PTSD
  Virginia Snow, Lifespan.org, 14 Jan 2010 12:46 PM EST
  Could it have the same affect with hypnotic recall of the trauma?
• A response from JW Psychiatry Editor-in-Chief Peter Roy-Byrne
  Peter Roy-Byrne, MD, Vice-Chair & Prof., Dept. of Psychiatry and Behavioral Sciences, Univ. of Washington, Seattle, 22 Jan 2010 1:49 PM EST
  Studies suggest that benzodiazepines -- orally administered daily in the first few weeks after trauma -- have the OPPOSITE effect... [more]
• opioid system in PTSD pathophysiology
  Behnia Haghiri, 30 Jan 2010 4:20 PM EST
  On the other hand, there is a study that shows that Nalmefene, which is opioid recepter antagonist, was helpful in... [more]