Armed Polite Society
Main Forums => The Roundtable => Topic started by: Grandpa Shooter on January 15, 2010, 12:26:35 AM
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Study: Fast morphine treatment may prevent PTSD
AP
http://news.yahoo.com/s/ap/20100113/ap_on_he_me/us_med_preventing_ptsd
I am posting this to draw attention to some points made in the body of the article. In no way am I looking for a knock down word fight over this. I know some of you don't believe PTSD exists, or that some veterans fake it. I have highlighted the portions which caught my attention.
By LINDA A. JOHNSON, Associated Press Writer Linda A. Johnson, Associated Press Writer – Wed Jan 13, 5:01 pm ET
Quickly giving morphine to wounded troops cuts in half the chance they will develop post-traumatic stress disorder, according to a provocative study that suggests a new strategy for preventing the psychological fallout of war.
Researchers at the U.S. Naval Health Research Center led the study of about 700 troops injured in Iraq from 2004 through 2006.
"It was surprising how strong the effect of the morphine was," said study leader Troy Lisa Holbrook, an epidemiologist at the naval center. The findings were published in Thursday's New England Journal of Medicine.
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."
About 53,000 troops returning from Iraq and Afghanistan have been treated for PTSD, a disorder in which someone who has endured a traumatic event keeps re-experiencing it and the fear it caused. Patients often have trouble with work, relationships, substance abuse and physical ailments.
Researchers have been testing ways to treat it, and the new study looked at whether fast and strong pain relief can help prevent it.
It was unclear whether it was the fast pain treatment or something specific to morphine that made the difference.
But 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 — in essence, 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.
Of the 696 troops in the study, 493 — about 70 percent — were given morphine, most within an hour of injury. Two years later, 147 of them had developed PTSD. Of the 203 not given morphine early on, 96 developed PTSD.
That worked out to a 53 percent lower risk of developing PTSD for those treated early with morphine. No other factor, such as the nature or severity of injuries, had much effect on the chances of developing PTSD, Holbrook said.
"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.
A second study in the journal found that Army wives were more likely to develop depression or sleep problems the longer, or the more times, their spouses were sent to Iraq or Afghanistan.
That study, by researchers at the University of North Carolina and elsewhere, examined medical records for outpatient care of about 250,000 wives of active-duty soldiers from 2003 through 2006.
Compared with wives whose husbands stayed home, those whose husbands were deployed for up to 11 months were 18 percent more likely to be diagnosed with depression and at least 20 percent more likely to be diagnosed with sleep disorders, anxiety and acute stress.
For wives whose husbands were deployed for more than 11 months, problems were even more common: They were at least 24 percent more likely to be diagnosed with depression or anxiety, and about 40 percent more likely to be diagnosed with acute stress or sleep problems.
The researchers didn't have data showing whether husbands were deployed or at home when the wives were being treated for mental health problems.
That meant the scientists couldn't conclude whether those problems were caused by worries about the spouse's safety and the difficulties of being a single parent, or by stress caused by the returning spouse's psychological problems or other behavior changes.
"I suspect that if you look at the Reserve and National Guard wives, the toll might be even worse," because they have less social support than families living in a military community, Rothbaum said.
She said the effects of deployment on children also need to be studied so the military can figure out how to provide more help to families.
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glad they've found something to lessen this. and
it's the morphine, it kinda takes you out of whats going on =)
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I can see it having an effect, if administered soon enough after the injury.
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Morphine is great! I came home from ACL surgery ( on morphine) and made a bunch of phone calls
to relatives I didn't like, and told them how much "I love them" ... now they expect presents and stuff.
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big pharma will kill this-that's what we have all these 'new' patented antidepressants and other wonder drugs for. stay on their stuff for life, but for heaven's sake don't risk 'addiction' to an opiate.
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I've never seen combat in my short civvie life, but I can see how it would help. If you are in a bad way physically and mentally, with all hell breaking loose around you while your buddies scramble to save you and/or fight for their lives, having something like morphine to pull your head away into the clouds would be a pleasant alternative.
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IIRC administering morphine was fairly routine as part of the treatment of combat injuries during WWII. Combat medics/Corpsmen carried styrettes (toothpaste tube-like with attached needle) as part of their regular kit and certain NCOs were also issued styrettes. I don't have info on the numbers of "combat fatigue" cases with or without morphine - wonder if that info was even tabulated.
The point I see is that rapid administration of analgesic relief has been known for quite some time to reduce adverse psychological responses in post-trauma (e.g. car crash) and post-surgical cases. The advent of EMS and actual treatment on-scene has reduced the administration of analgesia in trauma cases due to the masking of clinical info and potential adverse effects (die of respiratory failure as opposed to exsanguination). In the old days of meatwagon rescue squads having a casualty who was not screaming in pain during a 30-minute mad dash to the hospital was a Good ThingTM.
I'm wondering if the .mil and EMS folks will also recall the "old days" and if we may see a reversion to sticking mangled folks on the scene?
stay safe.
skidmark
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The decision on whether to give morphine was up to the individual doctor, based on the patient's condition.
Under what circumstances would the doctor choose to, or choose not to administer morphine? Could this study be explained away by the personality of the doctor? What about the condition/location of the facility? A well-stocked hospital far from the fighting where they can afford to give out drugs vs. a makeshift clinic where drugs are scarce and you are listening to bombs and shooting while you lie there.
Obviously I know nothing about what it's like in Iraq, but there are so many variables here.
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The point of hte article is perfectly sensible:
reduce perceived trauma > lesser likelihood of PTSD
Am I missing somehting?
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I've never seen combat in my short civvie life, but I can see how it would help. If you are in a bad way physically and mentally, with all hell breaking loose around you while your buddies scramble to save you and/or fight for their lives, having something like morphine to pull your head away into the clouds would be a pleasant alternative.
Never had morphine, but if the mechanism is similar to Demerol, I would expect it to be pretty effective: when I was on Demerol, I could still feel everything, but didn't care one bit. I distinctly remember thinking "Gee, that hurts like hell. I should be upset. Maybe I'll get upset later...or maybe not."
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I know morphine was still available in the 70's. I watched them give it to a Chief with kidney stones just before they airlifted him off the boat. One minute he was screaming, the next he said, "Ahhh..." and went happily off to never never land.
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I know morphine was still available in the 70's. I watched them give it to a Chief with kidney stones just before they airlifted him off the boat. One minute he was screaming, the next he said, "Ahhh..." and went happily off to never never land.
My son had that very experience in the ER when he had a kidney stone, or stones. They gave him some non-narcotic pain med that didn't do anything for the pain at all. Doubled over, clutch the gut, sweaty, rocking back & forth, groaning in agony sort of pain.
A bit of morphine in the IV and he no longer cared about the pain. He may have been aware of it but it wasn't a problem. He, too, had that "Ahhhh" feeling of great relief. So much so that he called me the next day to tell me about it.
jb
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I had a morphine pump after my prostate cancer surgery. Self administer the stuff, but on a timer. One beep, you got a dose, series of beeps, too soon. The guy in the bed next me, same deal. A nurse came into our room in the middle of the night and told us we sounded like a symphony. =D
From the time I woke up after the surgery and for the next 20 hours, I have never experienced such a fine feeling of contentment in my life. The other fella and I talked, dozed, laughed and thoroughly enjoyed the situation.
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Now that you mention it, my dad was on the same pump. "Bolus" was the name I recall for a shot. As in, "Time for a bolus." Not sure if the spelling is right. He pretty much had carte blanche near the end and mom, well, she overdid it a bit and noone was around enough to slow her down. He was pretty far out there last couple weeks.
I'm happy to see your bout turned out better than his. Glad your still with us! =)
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I have no doubt that PTSD exisits. A single dose (or incident-specific doses) of morphine staving off PTSD is encouraging.
I also have no doubt regarding the addictive properties of opiates.
It looks as if the study is specific to pain relief uses immediately after injury.
If morphine administered under controlled situations, or in controlled doses (like Bolus) with adequate pre-treatment screening, come down and dry outs is effective in treating combat related PTSD, great, super, bravo.
HOWEVER, if the .gov starts taking our combat vets into a clinic-come-opium dens and turning out junkies, then I'm against it.
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The scioence of analgesia and of addiction both agree on one point - that quick administration of analgesia and sufficient dosage to prevent the return to full pain awareness before the next does (I'm sorry but you cannot have another shot for three more hours. It doesn't matter how badly you hurt.) is the way to actually prevent addiction/drug-seeking behavior. The effective dosing process essentially makes for less total use and less total time using analgesia, as the patient views is psychologically as medication and not a "cure-all" for any/all ills and discomforts in life.
Waiting for any prolonged time for the "Ahh!" effect will lead to actively seeking that effect even when there is no longer pain present - primarily because the effect is so powerful. By allowing the patient to control the level of pain so that it remains present but managable/tolerable (you know it's supposed to hurt, but it does not hurt enough to make you want to kill yourself just to get relief) the patient can work with the pain as both an indicator of improvement (it was a 10 out of 10 when it snapped, but now it's about a 7 [10 = worst pain ever encountered/imagined, 5 = typical headache]) as well as a psychological game (I can't stand a 10 - nobody could, but I can just barely tolerate an 8 without crying out loud and can deal with a 6 with a handful of aspirin/ibuprofin/acetomin 'cause Im not a wimp).
Also, by controlling the amount of "Ahh!" vs. the amount of pain relief, the patient is less likely to continue seeking the "Ahh!" and concentrate of analgesia (relief of pain interferring with normal activity). On the other hand, forcing the patient to endure returning and increasing pain until some artificial time schedule is met encourages the patient to actively seek out and maintain the "Ahh!" stage for as long and as often as possible to counter the knowledge that they will have to leave that stage and again endure great pain until the next scheduled dose.
The procedure many docs use is to encourage the patient to reach the stage of greatest tolerable pain and then see if/how long they can extend the period of toleration - be it 30 seconds or another 30 minutes. No penalty for asking for relief when it's needed, and no delay in getting it delivered when requested. It takes coordination between the patient, nurse and doctor to work, and a doctor willing to face inquiry as to the amount/timing of the dosage. Ask some of our folks enrolled in pain clinics how much over the "legal" limit their doses are in order to work and if they are addicted.
What surprises me is this "study" - a retrospective - is based on doses given as much as 60 minutes after the injury. I would think that such a significant delay would void much of the so-called benefit of post-traumatic analgesia.
stay safe.
skidmark
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skid,
I read a report that contradicts what you posted. It was in the National Review a number of years ago. The gist of it was that people who used whatever doses they wanted or needed of drugs such as morphine for medical necessity, when the medical necessity ended they ceased using the drugs a very high percentage of the time, nearly 100%. In other words, addiction does not follow use as a rule. it also debunked the pot leads to hard drugs myth as well.
Some folks have addictive proclivities. No need, imho, to demonize all drugs for all people because of a few.
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would that i could but this stuff now (http://www.hagley.lib.de.us/library/exhibits/patentmed/history/history.html) :angel: cheaper, less trouble to get, and less side effects =|
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The point of hte article is perfectly sensible:
reduce perceived trauma > lesser likelihood of PTSD
Am I missing somehting?
I don't think you're missing much of anything. However,as Two Cold Soakers points out, the study was keyed on the wounded. There are a whole lot of returning GIs who have (or claim to have) PTSD who were never wounded or injured while over there. Having been in Vietnam, I can understand that. I got out of the Army in November, went back to my small town and found a job for a year, then entered graduate school in a large city. Two years after coming home, if a car backfired in the same block where I was walking I'd be ducking into the nearest doorway. I'm sure the stress in Iraq and Afghanistan must be orders of magnitude greater than what we experienced in Vietnam, because in Iraq and Afghanistan you pretty much have to figure that anyone you see on the street -- anywhere, any time -- may be a walking bomb.
So what are we supposed to do about all the whigged out NON wounded personnel when they rotate back to CONUS, and possibly leave the military?
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What surprises me is this "study" - a retrospective - is based on doses given as much as 60 minutes after the injury. I would think that such a significant delay would void much of the so-called benefit of post-traumatic analgesia.
stay safe.
skidmark
I admit to having a bias as regards PTSD. However I also was trained in college in research procedure and acceptable interpretations of collected data. The study I posted about is so loosey goosey in what they assume the right to propose as an "outcome" or interpretation of data, it gives me the creeps.
A. Not all PTSD is directly the result of an individual injury in a combat zone.
B. Many cases of PTSD do not involve any kind of physical injury regardless of where the incident took place.
C. PTSD is not always the result of a single stressor, it may be the outcome of repeated incidents over a period of time.
D. Taking a look back at case histories involving one particular set of stressors and generalizing from that to a conclusion is NOT acceptable research procedure. There could be many intervening variables which would significantly alter the individual diagnosis. There is no indication that any of the patients were actually followed in their recovery, only that another diagnosis was found in their case history.
E. PTSD like symptomology is often present in the spouses and families of persons with PTSD, depending on the severity and how it impacts the nuclear family. Given enough exposure to an individual with serious emotional problems and persons closely associated with them can begin to act like them, regardless of whether it is PTSD or some other pervasive condition.
I was pleased to see that they questioned whether military families and the families of Guard and Reserve personnel were receiving enough support and help coping with the problems associated with extended or repeated tours by family members.
Having had nothing other than one 800 mg Darvon in 6 days of transit from my duty station to a hospital in Japan in 1970, I can only attest to the scarring impact of NO pain meds. What the Ahhhh might have been is not something I have any knowledge of.
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skid,
I read a report that contradicts what you posted.....
Grampster,
Don't know how you missed that I was saying the same thing as you.
stay safe.
skidmark
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There are a whole lot of returning GIs who have (or claim to have) PTSD who were never wounded or injured while over there.
I would imagine that having your buddy's insides splattered all over you would be pretty traumatic, even if not injured yourself :O
Do they make a drug for that kind of pain ? ;/
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skid,
It was late and I'd had a couple glasses of wine at dinner and maybe I didn't read your post carefully enough. Sorry. Sounded like it was saying doctors were encouraging folks or demanding folks endure as much pain as possible before being able to get relief because they were worried about addiction.
When I had my cancer surgery the first thing the doc told me when I woke up was that I was not to be a hero and endure any pain. Use the stuff, that's what it's for and there was no reason I should not be comfortable. I took his advice.
The thing that bothers me the most about anelgesics is how the government has it's nose in the methodolgy of pain relief. I think the .gove ought to be totally divorced from having any authority over prescribed medication. The many suffer because of the abuse by the few. That is BS.
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First time I ever got morphine when back when I was 15 yo. I blew myself up. Lesson for you kids- Explosives are dangerous. =D
After going into what I think was immediate shock, I managed to start to make my way home thinking I could clean myself without having to divulge the injury to my parents thus suffering the punishment I was was sure to receive. ;) I had no pain which is why I think it was shock given the injury.
As I went up the hill to my house, the only neighbor who lived in the area that would have been home that time of day happened to be driving down the hill. Something flashed in my mind that I probably needed to ask her for help (the solid line of blood on the road behind me that was coming out of my shattered hand may have had something to do with that rather astute determination).
Anyway, I flagged her down. She had a newborn and plenty of diapers (cloth back then) so she gave me several to wrap my hand in. She drove like a bat-out-of-hell about 5 miles to the Town Hall where my mother worked. Luckily for me, the resident State Trooper was in his office there and he threw me in his car and took me to our family doctor's office about another 7 miles away.
Our doctor was a great guy with a lot of experience in wounds caused by explosions. He served as a doc in WWII. He figured out I'd be in a lot of pain at some point and gave me a shot. Almost immediate and utter bliss... Since by then, we were in a town where there was an ambulance service close by, I was transported to the ER by them. My family doctor came and treated my wounds. He had several "kind words" for me as he did so- he was a salty, crusty old guy. I spend three days in the hospital. I can't remember any pain associated with that incident.
If an immediate dose of morphine helps reduce pain and thus PTSD, I'm all for it. Although I'm looking back on my injury after a lot of years passed, I don't have a bad memory of it. Maybe pain we endure causes part of the problem people deal with later and if we can eliminate that pain we can reduce the impact.
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I would imagine that having your buddy's insides splattered all over you would be pretty traumatic, even if not injured yourself :O
Do they make a drug for that kind of pain ? ;/
No. They don't.
The article doesn't say that and I don't know that there is a way to lessen the impact of what you stated.
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I would imagine that having your buddy's insides splattered all over you would be pretty traumatic, even if not injured yourself :O
Do they make a drug for that kind of pain ? ;/
No. They don't.
The article doesn't say that and I don't know that there is a way to lessen the impact of what you stated.
I wonder if quickly sending someone who has just experienced something traumatic of that nature off to la-la land with a psychoactive might be beneficial? I doubt it would be feasible in a combat environment, though, even back in the rear.
Just some amateur guess work on my part.
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A great deal of work was done back in the 50's and 60's using LSD therapeutically for alcoholism, depression, psychosis and a host of other issues. There are a very few current studies looking at psychedelics for anxiety disorders. Psychedelics are essentially illegal in the USA outside of the research environment.
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A great deal of work was done back in the 50's and 60's using LSD therapeutically for alcoholism, depression, psychosis and a host of other issues.
Indeed. [popcorn]
LSD Testing (British Troops) (http://www.youtube.com/watch?v=n-rWnQphPdQ)
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Hmmm...maybe psychoactive was the wrong term. I really meant something that would take a person into state of not being concerned about their immediate surroundings or situation, not necessarily a psychedelic or hallucinogen.
I don't have a lot of knowledge on this subject.
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Researchers have started looking into using Ecstasy for PTSD treatment:
http://discovermagazine.com/2009/nov/20-treating-agony-with-ecstasy (http://discovermagazine.com/2009/nov/20-treating-agony-with-ecstasy)
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^^^^^ How very interesting indeed. It would be a major clinical breakthrough if we can develop an effective means of treating PTSD and other psychological traumas.
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Significant life events, good bad or otherwise, are bound to have lasting influences on people. I think I'd be more concerned about someone who experienced a traumatic event and wasn't affected by it than I would be over a person who did become affected. Traumatic events are traumatic, and that's just life.
Seems rather obvious that if you drug someone into a state of chemical happiness, they aren't going to exhibit any of their former fear or anxiety. But at some point you have to wonder if drugging away the person's normal and natural responses doesn't amount to drugging away some of the person. Is it worth it?
(Yeah, it probably is worth it. I don't want soldiers to have to suffer needlessly for the rest of their lives. But at some point don't you have to accept that going to war is a life experience like any other, one that will have an influence on the people involved?)
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Believe me, not having ptsd is not the same as not being affected. The fact that I rarely only get 2 hours of sleep a night for weeks on end because I'm dreaming about Iraq doesn't mean it didn't change me.
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The fact that it was 20 years before I stopped having regular dreams about being out to sea says something to me about all this. There was very little trauma involved with my experiences so I can ony imagine how reliving any trauma regularly during twenty years worth of dreams might affect me. I imagine the less you can remember about any severe trauma the better off you will be.
I witnessed a pretty severe rollover accident once that ended in some young woman underneath her car face up with her feet sticking out just like the witch in the "Wizard of Oz". That's exactly what the scene reminded me of. Even though I felt I was quite stoic at the moment and did what I had to do to help it was two weeks before the flashbacks stopped and even a year later when her lawyer showed me pics of the accident scene I was still overcome with emotion. PTSD ain't much fun. If immediate anesthesia lessens the effects, I'm all for it.