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Morphine may help with post-traumatic stress, research finds
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/13/AR2010011303721.html?hpid=topnews
By David Brown
Washington Post Staff Writer
Wednesday, January 13, 2010; 5:42 PM
More than 200 years after it was isolated from poppies, morphine remains one of medicine's best painkillers. But that isn't its only use.
Physicians sometimes include morphine in a cocktail of drugs given to people having heart attacks. It can relieve the breathlessness of pulmonary edema. It decreases diarrhea. A famous physician of the early 20th century, William Osler, once called morphine "God's own medicine."
Research published this week suggests the compound may have at least one more use, too.
In a study of about 700 troops who have been wounded in Iraq, those who received morphine soon after being injured were about half as likely to develop post-traumatic stress disorder (PTSD) as those who didn't get the drug.
Whether morphine's apparently protective effect arises directly from the relief of traumatic pain, or indirectly by blocking the brain circuits that lay down traumatic memory, isn't known.
The researchers and outside experts agreed that the effect would have to be proved virtually beyond a doubt before morphine would be routinely given to prevent the mental disorder.
"I would be very reluctant to suggest any change in clinical practice," said Troy Lisa Holbrook, of the Naval Health Research Center, in San Diego, who headed the study published in the New England Journal of Medicine. "We need to understand a great deal more how this appears to work."
Morphine has been used for pain relief from war wounds since the Civil War. It is the battlefield analgesic of choice, although how commonly it is used as part of front-line first aid isn't known.
PTSD is characterized by intrusive thoughts and memories, a desire to avoid specific situations or stimuli, and feelings of both numbness and extreme vigilance. The disorder is common in veterans of the Iraq and Afghanistan wars although its exact prevalence is also uncertain.
About 40 percent of those veterans cared for at Department of Veterans Affairs hospitals have PTSD. Repeat deployment to a war zone increases a soldier's risk of developing of the disorder. PTSD can also come on slowly. In one study, 4 percent of soldiers had the condition; six months later the prevalence was 12 percent.
In the new study, Holbrook and her colleagues studied the records of 696 wounded people. About 40 percent had been injured by "improvised explosive devices" -- generally roadside bombs, and about 20 percent by gunshots, and 10 percent by mortar rounds. Roughly 70 percent of the people received morphine within an hour of injury.
Most people developed PTSD, diagnosed from one month to two years after their injuries. Those who'd gotten morphine, however, were somewhat less likely. Sixty-one percent had the disorder, compared with 76 percent of people who hadn't gotten the drug -- which researchers said translates into a 53 percent reduction in risk.
(None had serious traumatic brain injuries. Morphine is generally not used in such patients as it can cloud consciousness and increase pressure inside the skull, worsening the problem).
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/13/AR2010011303721.html?hpid=topnews
By David Brown
Washington Post Staff Writer
Wednesday, January 13, 2010; 5:42 PM
More than 200 years after it was isolated from poppies, morphine remains one of medicine's best painkillers. But that isn't its only use.
Physicians sometimes include morphine in a cocktail of drugs given to people having heart attacks. It can relieve the breathlessness of pulmonary edema. It decreases diarrhea. A famous physician of the early 20th century, William Osler, once called morphine "God's own medicine."
Research published this week suggests the compound may have at least one more use, too.
In a study of about 700 troops who have been wounded in Iraq, those who received morphine soon after being injured were about half as likely to develop post-traumatic stress disorder (PTSD) as those who didn't get the drug.
Whether morphine's apparently protective effect arises directly from the relief of traumatic pain, or indirectly by blocking the brain circuits that lay down traumatic memory, isn't known.
The researchers and outside experts agreed that the effect would have to be proved virtually beyond a doubt before morphine would be routinely given to prevent the mental disorder.
"I would be very reluctant to suggest any change in clinical practice," said Troy Lisa Holbrook, of the Naval Health Research Center, in San Diego, who headed the study published in the New England Journal of Medicine. "We need to understand a great deal more how this appears to work."
Morphine has been used for pain relief from war wounds since the Civil War. It is the battlefield analgesic of choice, although how commonly it is used as part of front-line first aid isn't known.
PTSD is characterized by intrusive thoughts and memories, a desire to avoid specific situations or stimuli, and feelings of both numbness and extreme vigilance. The disorder is common in veterans of the Iraq and Afghanistan wars although its exact prevalence is also uncertain.
About 40 percent of those veterans cared for at Department of Veterans Affairs hospitals have PTSD. Repeat deployment to a war zone increases a soldier's risk of developing of the disorder. PTSD can also come on slowly. In one study, 4 percent of soldiers had the condition; six months later the prevalence was 12 percent.
In the new study, Holbrook and her colleagues studied the records of 696 wounded people. About 40 percent had been injured by "improvised explosive devices" -- generally roadside bombs, and about 20 percent by gunshots, and 10 percent by mortar rounds. Roughly 70 percent of the people received morphine within an hour of injury.
Most people developed PTSD, diagnosed from one month to two years after their injuries. Those who'd gotten morphine, however, were somewhat less likely. Sixty-one percent had the disorder, compared with 76 percent of people who hadn't gotten the drug -- which researchers said translates into a 53 percent reduction in risk.
(None had serious traumatic brain injuries. Morphine is generally not used in such patients as it can cloud consciousness and increase pressure inside the skull, worsening the problem).
