Post-traumatic stress disorder (PTSD) is a common, important and well-documented mental health outcome among seriously injured civilian and military survivors of trauma such as those injured in car accidents, construction site accidents, or by electrocution. One risk factor for the later development of PTSD is physical injury from a traumatic event especially injury that is associated with severe pain.
A study published in this months New England Journal of Medicine found that giving morphine to troops injured in fighting in Iraq lowered their risk of post-traumatic stress disorder by half. These findings suggest a potential for prophylactic use of rapid pain reduction among injured, traumatized persons in both military and civilian acute care (emergency room) settings.
The primary aim of pharmacotherapy is to decrease or impede memory consolidation and the associated conditioned response to fear after a person goes through a traumatic event. Pharmacotherapy in the aftermath of serious physical injury or exposure to traumatic events may be effective for the secondary prevention of PTSD. Establishing the efficacy of administering, during resuscitation and early trauma care, adrenergic antagonists (such as propranolol and clonidine) or some other medications as effective prophylaxis against the later development of PTSD would have a considerable effect on emergency medicine for military personnel and civilians. The study identified 696 injured U.S. military personnel without serious traumatic brain injury from the NavyMarine Corps Combat Trauma Registry Expeditionary Medical Encounter Database.
Complete data on medications administered were available for all personnel selected. The diagnosis of PTSD was obtained from the Career History Archival Medical and Personnel System and verified in a review of medical records. Among the 696 patients studied, 243 received a diagnosis of PTSD and 453 did not. The use of morphine during early resuscitation and trauma care was significantly associated with a lower risk of PTSD after injury. Among the patients in whom PTSD developed, 61% received morphine; among those in whom PTSD did not develop, 76% received morphine (odds ratio, 0.47; P<0.001).
This association remained significant after adjustment for injury severity, age, mechanism of injury, status with respect to amputation, and selected injury-related clinical factors. The findings are supported by a preliminary study that showed that morphine administration in a small sample of children with burn injuries had a significant protective effect against the development of PTSD symptoms at follow-up 6 months after hospitalization. Another study recently reported that the use of morphine had a significant protective effect against PTSD symptoms in injured adults.
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