Early Use of Morphine in Combat Injuries Helps Prevent Later Development of Post–traumatic Stress Disorder

A study published in January in the New England Journal of Medicine, it was demonstrated that soldiers who received morphine following a battle-field injury were less likely to develop post-traumatic stress disorder (PTSD) than those who did not.

Post-traumatic stress disorder is a common result of severe injury or trauma on the battle-field and can have a serious long-term impact on general health and quality of life. As the implications of this disorder have become clearer, the secondary prevention of PTSD with pharmacotherapy in the aftermath of major trauma has received more focus.

In this study, the medical files of nearly 700 soldiers wounded between 2004 and 2006 were reviewed for initial injury and later diagnosis of PTSD. Those who received morphine during early trauma care were significantly less likely to develop PTSD than those who did not. The study adjusted for factors such as injury severity, age of patient, mechanism of injury, amputation status, and other selected injury-related clinical factors, and still found a statistically significant correlation between early morphine treatment and lower risk of PTSD.

This study supports an earlier study in which morphine administration, in a small sample of child burn victims, was shown to decrease the incidence of PTSD. Other studies have shown that the severity of pain within the first 48 hours of a serious injury has a significant impact on later development of PTSD. The idea is that the administration of morphine and reduction of pain decreases memory consolidation and the associated conditioned response to fear after a person goes through a traumatic event.

While early treatments on the battlefield have inherent limitations, studies such as this may intensify the urgency with which pain-killers are administered to wounded soldiers. These findings are also applicable civilians who undergo severe traumatic injury putting them at risk for PTSD. With the recognition of the far-reaching health implications of PTSD, the development of preventative measures is crucial.

Nicole Myers

To read the full text of this study follow: http://content.nejm.org/cgi/content/full/362/2/110

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