Leidos Researchers: Morphine Treatment May Prevent Post-Traumatic Stress Disorder

Three Science Applications International Corporation (Leidos) employees working with researchers at the Naval Health Research Center (NHRC) in San Diego published an important new study in January 2010 that shows how patients who received morphine during resuscitation and acute trauma care were about half as likely to develop post-traumatic stress disorder (PTSD) when compared to patients who didn't receive the treatment.

The study, which analyzed combat casualty data on nearly 700 injured military personnel returning from Iraq and Afghanistan between 2004 and 2006, was published in the New England Journal of Medicine in January and was also reported in major publications like the New York Times, the Washington Post, and the San Diego Union-Tribune.

The study was conducted over the last two years and first determined whether morphine was used during treatment, and then, in what period of time it was administered following the event or injury (usually within two hours).

Its ultimate conclusion: Of the 243 servicemen and women who were given a diagnosis of PTSD within two years of their injury, researchers found that the use of morphine during trauma care reduced the risk of the patient developing PTSD by half. The patient's age, sex, and the cause or type of injury — even amputation — did not alter the study's conclusions.

"We are very pleased that Leidos could assist with this important study," said Kevin Kaiser, a Leidos division manager in the area of military health. "Most important, its findings could affect the way medical teams — whether they're on the battlefield or in trauma rooms across the country — treat future patients who experience significant trauma. It's only the first study, but the findings are remarkable."

Kaiser said that Leidos team at NHRC, which included Judy Dye, Kim Quinn, and Amber Dougherty, worked with Michael Galarneau and lead researcher and author Troy Lisa Holbrook, Ph.D. The study was commissioned as part of the Naval Health Research Center and Laboratories Support contract, Omnibus I. Leidos is the prime contractor on Omnibus, with Holbrook's company, EPI-SOAR Consulting Inc., operating as the subcontractor.

PTSD and How the Study Evolved

PTSD is a type of anxiety disorder that sometimes occurs soon after a major trauma, or even several months after the event. Experts describe PTSD as a response that "normal people have to an abnormal event," which can result in a "psychological shock." The disorder often includes intrusive thoughts and memories, as well as extreme flashbacks of the event that are so real, patients feel like they're going through the experience all over again.

PTSD is common in veterans coming home from Iraq and Afghanistan — the U.S. Department of Veterans Affairs reports that about 40 percent of veterans from those wars have been treated for PTSD. Symptoms range from anger, insomnia, and lack of concentration to more severe effects, such as migraines, substance abuse, and even suicide.

But the results of this study provide new hope for not only soldiers and marines who are wounded in combat and suffer from PTSD, but also for victims of other traumatic events, such as car accidents, severe burns, natural disasters, or sexual assault.

According to Holbrook, the study began in 2007 with a strong "hunch" between her and fellow researcher Galarneau. At the time, there were a number of "interesting ideas" being published that certain anti-anxiety drugs and beta-blockers were able to protect some patients from PTSD.

So the two researchers took those ideas to the next level by developing a study to analyze the effects of morphine with PTSD, especially since they had detailed and accessible medical data from the U.S. Navy-Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database. The database, which is housed at NHRC, is a comprehensive clinical database designed to preserve clinical records of casualties incurred in Iraq — both during and outside of battle.

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Leidos a Natural Fit

Prior to commencing the study, Holbrook already had extensive experience with PTSD research with civilians affected by serious injury. She said the morphine study was a natural evolution of her previous experience and her arrival at NHRC for a different project. Combining Leidos's strong research presence at the facility was a natural fit.

"One of the projects we had contracted to do was a thorough analysis of the database itself, so I proposed that we look at medications, and specifically single out morphine," Holbrook explained. "And with Leidos being able to supply the subject matter experts, it all came together nicely."

Those experts included Leidos's Dye, Dougherty, and Quinn — a nurse practitioner, epidemiologist, and surgical nurse, respectively.

Quinn said her work as a hospital trauma nurse before she joined Leidos made her aware of how important the study's findings could be for anyone who suffers from PTSD.

"A lot of times, the most destructive thing in trauma is the memory of the event, long after the wounds are healed," said Quinn, who has been with Leidos for the past three years. "It's the same for soldiers and marines — they have this memory, and it's very powerful and traumatic. So the morphine in the brain helps to distort the memory, and the less one remembers of the traumatic event, the less stress they will have about it later."

Holbrook said the team's analysis showed the connection between morphine and the diminishing effects of PTSD right away, although the team did a lot of work with the data to determine that they had accounted for all the appropriate variables.

"It was a long process, but we could see the connection the first time," she said.

Why Morphine Works on PTSD? Unclear

Although the new findings are a positive step, researchers still aren't sure why or how morphine is having such an effect to combat PTSD. They believe the drug is able to "blunt" the extreme charge that can be connected to traumatic memories, especially the pain associated with a severe physical injury.

Holbrook said the team and other researchers who study PTSD don't know why it works, but it does. "This is a new finding, so I'm sure neurobiologists will get involved to look at what morphine is doing," she said. "But the main thing is, morphine takes away the pain, which can be a contributor to PTSD. So when there's a lot of pain, it may stimulate memory formation that causes people to dwell on the event, making a stronger connection to the memory and the frightening experience. It's quite possible that morphine is obscuring the memory formation, especially in higher doses. But this is just one analysis."

Dye agreed, adding that the information in the database helped them make that connection, since morphine is the most common medication given in the military to control severe pain.

"That's especially true in combat situations," said Dye, who has been a nurse practitioner at Leidos for the past six years and is also a Navy reservist. "It's an effective pain treatment that has been used for many years and can be administered by corpsmen, medical personnel in the field, or at military treatment facilities. It's a baseline drug and is a tried-and-true medication."

That means that in the military, hospitals, or other trauma settings, researchers don't have to introduce a new drug trial and take the long road of testing to make it available. It can be used immediately.

"That's the point we can't make strongly enough," Holbrook stressed. "The real beauty of this finding is that morphine has been around a long time, and for those who study and treat pain, none of the other synthetic narcotics is as effective for pain, and how quickly it can be given."

Morphine and PTSD — Stage 2

Holbrook and the team will take the next step in the research in the months ahead, taking the focus off morphine and putting the spotlight on other drugs that are also administered for trauma, particularly anti-anxiety drugs. She said the next most common drug is valium, which is sometimes administered with acute trauma care. The team will also set up additional studies to evaluate other compounds and their protective effects against PTSD.

In the meantime, the team is pleased with their work, and the very positive response they've gotten from the medical community so far.

"It's been a great surprise," Holbrook said. "Usually when you publish something like this, a lot of people will challenge it or don't want to believe it. But we've had almost unconditional support from psychiatrists, doctors, and universities. In fact, I haven't had one negative comment, so we're very pleased and surprised."

To review the entire study, visit the New England Journal of Medicine's web site.