Abstract
Morphine After Combat Injury and Post-traumatic Stress Disorder
Whether it happens in a military setting or a wilderness environment, physical trauma may cause more damage than the immediately appreciable injuries. Post-traumatic stress disorder (PTSD) is a well-documented downstream consequence of trauma. This study assessed the effect of morphine sulfate administration as a secondary prevention measure to reduce PTSD after trauma.
This retrospective chart review identified trauma victims presenting to medical treatment facilities throughout the combat theater during Operation Iraqi Freedom, from January 2004 to December 2006. Of the 790 injured military personnel, 34 were excluded because of incomplete records and 60 were excluded because of evidence of traumatic brain injury, leaving 696 in the study group. Medical records of these patients were reviewed to determine whether they were diagnosed with PTSD in the subsequent 2 years. A total of 243 patients carried a new diagnosis of PTSD and 453 did not. The two groups were statistically similar in terms of age, mechanism of injury, Glasgow Coma Score, Injury Severity Score, and need for intubation.
Early administration of morphine sulfate occurred in both groups with 61% receiving it in the PTSD group and 76% in the other group. In those trauma patients receiving morphine sulfate during the initial treatment phase (roughly the first hour), there was a statistically significant reduction in the likelihood of being diagnosed with PTSD (odds ratio 0.47). Benzodiazapene administration did not show a significant correlation with PTSD diagnosis. This study adds to a growing body of evidence that early pain management reduces PTSD following trauma and, though not addressed by the authors, might suggest the importance of equipping wilderness expeditions with opiates.
(N Engl J Med. 2010; 362:110–17) TL Holbrook, MR Galarneau, JL Dye, et al.
Prepared by Anil Menon, MD, UTMB/NASA Aerospace Medicine Fellow, Galveston, TX, USA