Morphine May Help with Wounded Soldiers and PTSD

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A study conducted on combat casualties in Iraq suggests that prompt treatment of the very strong narcotic morphine may cut chances of troops developing symptoms of post-traumatic stress (PTSD) in half. Other opiates are likely to have similar effects, experts said.

The new study, appearing in the New England Journal of Medicine, supports the standard practice in settings like the battlefield and emergency rooms, where morphine is often used readily. But experts say it may have implications for the timing of treatment and for a wider variety of traumas, like those resulting from rape or muggings.

“This idea that medicine can be used in the wake of a trauma to diminish the risk of developing a significant psychiatric disorder is incredibly important," said Dr. Glenn Saxe, a psychiatrist at Harvard Medical School who conducted the studies on burn patients. "If the findings hold up," the expert who was not connected with the study said, "the implications are huge and go well beyond the military." He and other experts cautioned any benefit must be stacked up against the drugs' risks: They are habit-forming with repeated use, and can blur memories of events.

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Researchers theorize that simply easing pain might reduce the severity of the psychological trauma, or that prompt relief might alter the way the brain remembers the attack or injury causing the mind to file away the episode as less traumatic.

Troops in the study initially were treated at military medical facilities in Iraq, mainly for wounds caused by roadside bombs, bullets, grenades or mortar fire. A few dozen had burns or were hurt in crashes or falls. The decision on whether to give morphine was up to the individual doctor, based on the patient’s condition.

“These are provocative and thought-provoking findings that should lead scientists to investigate the underlying mechanisms” in future studies, said JoAnn Difede, a PTSD researcher at New York-Presbyterian/Weill Cornell Medical Center. Difede and Barbara Rothbaum, who heads the Trauma and Anxiety Recovery Program at Emory University School of Medicine, said that until more research backs up the findings, the study probably won’t lead to many more patients in civilian emergency rooms getting morphine. “At this point, I don’t see it having a huge impact” for civilians, Rothbaum said.

Whether the Pentagon will adopt the practice on the battlefield remains to be seen. Dr. Jack Smith, acting deputy assistant secretary of defense for clinical and program policy, said in an e-mail that the “very interesting findings” are “likely to stimulate further research.” Meanwhile there is a great deal of research for a variety of modalities in treating PTSD.

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