Healing the Wounded

A recent study published in the New England Journal of Medicine has shown that morphine may help to prevent Post Traumatic Stress Disorder for soldiers injured in combat. PTSD is an anxiety disorder that occurs after a traumatic event, but it is not limited to a soldier’s exposure in combat. According to the National Center for PTSD, a special center within the Department of Veteran’s Affairs, anyone can develop PTSD after exposure to one of many traumatic events, such as sexual or physical abuse, a serious accident or a natural disaster.

Though not everyone displays symptoms of PTSD after a traumatic event, the condition has received attention lately as a result of the wars in Iraq and Afghanistan. It is estimated that 20 percent of soldiers who have served in Iraq and Afghanistan display common symptoms of PTSD. Researchers from the NEJM studied the cases of 696 injured American soldiers and of that number, 243 were diagnosed with PTSD. Of the number diagnosed, 61 percent had received morphine at the time of injury while the soldiers in whom PTSD did not develop, 76 percent had been given morphine. The study’s authors suggest that administering morphine at the time of injury may “reduce the risk of PTSD after serious injury.”

Dr. James McGaugh, of the Center for the Neurobiology of Learning and Memory at UC Irvine, was cited in the study for his work published in 1988 about beta-noradrenergic influences in the amygdaloid complex. Dr. McGaugh’s research found that beta-blockers, such as propranolol, decrease blood pressure to the amygdala, which then blocks memory facilitation. Dr. McGaugh said his findings are similar to how an opiate, such as morphine, may work when given to soldiers shortly after a traumatic event.

“Very strong and emotionally rousing memories are induced by conditions led by trauma. When aroused, the body releases adrenaline,” McGaugh said. “Then, nor-epinephrine is released in the brain — in the amygdala. Since morphine impairs memory by reducing nor-epinephrine, less nor-epinephrine is released in the amygdala, thereby decreasing the strength of memory.”

“The study suggests that immediate pain reduction leads to a decrease in PTSD.” McGaugh said. “Secondly, and perhaps equally, the morphine slightly reduces actual memory of trauma. It literally interferes with the intensity of memory.”

According to Dr. McGaugh, if medication such as morphine can affect the intensity of memory at the onset of pain in a traumatic experience, it should disable a portion of that memory and thus a portion of the traumatic experience. And if the intensity and memory of the traumatic experience is reduced, then the soldier should exhibit fewer lasting symptoms of PTSD.

Sergeant First Class Alex J., an Army Special Operations Medical Sergeant, said he is not familiar with the study, but is not surprised by the findings.

“Most professional sources agree the correlation between the initiation of pain management and psychological recovery is directly linked. Whether or not that directly affects PTSD is still to be determined. My experience suggests the sooner pain and anxiety is controlled, the less time a soldier spends in sensory overload. A hotly debated topic at present is when to initiate anti-anxiety and antidepressant medication. Most military sources feel the sooner the better in conjunction with counseling.

“In my experiences,” said SFC J., “it is difficult to track and monitor patients after I have treated them. The nature of my job limits me to, at most, a few hours of interaction with them. But, of the several dozen soldiers I have treated for traumatic injury on the battlefield, I know of only one soldier who definitely was later diagnosed with PTSD. The administration of an opiate, at the onset of injury, for more than pain management, is fascinating.”

“Think of [the memory of the event] as a jammed lock,” McGaugh said. “The key won’t work if it is blocked. Suppression of these memories should lessen the symptoms of PTSD. But at this point, it isn’t clear whether it was a result of pain reduction, a reduced memory of the trauma [that lessened the number of PTSD diagnoses], or both. It’s up to the military now, to investigate further.”

Speaking anonymously because he is not authorized to speak publicly, a former Army surgeon and current attending physician at Walter Reed Army Medical Center, says, “a remarkable number of resources are available to soldiers, and Army leadership has taken an aggressive posture to addressing the issue.” In addition to a number of screening tools at the unit level, he said soldiers are encouraged to seek counseling and that the Army is undergoing extensive pharmacological research into how it can treat its wounded warriors.

“PTSD is like a continuation of a warrior’s experiences in combat. The Army, to its credit, has done a good job at the command level in providing needed resources. I think this study provides an interesting statistical significance, but it [treating and understanding PTSD] is an ongoing challenge.”