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Medications that relieve pain and anxiety in acute trauma patients hold promise for prevention of posttraumatic stress disorder

Between 10 and 50 percent of injured youths and adults who are hospitalized develop high levels of posttraumatic stress disorder (PTSD) symptoms, which can range from insomnia, tormenting flashbacks, and nightmares to hypervigilance, anxiety, and depression. The medications doctors currently prescribe for trauma patients at hospital discharge may be candidate medications to test for prevention of PTSD among patients who have suffered traumatic injuries. For example, analgesics that often target both pain and anxiety might be potential target medications to prevent PTSD, note University of Washington School of Medicine investigators Douglas Zatzick, M.D., and Peter P. Roy-Byrne, M.D.

They assessed the medications prescribed at discharge to 113 adolescents and 152 adults hospitalized at a level 1 trauma center after physical injury. Opiate analgesic medications (such as oxycodone) were prescribed to between 82 and 88 percent of injury survivors; 34 to 46 percent of patients also received nonopiate analgesic medications (such as ibuprofen). Between 11 and 16 percent of patients were prescribed antihistamines. Benzodiazepines, anticonvulsants, corticosteroids, beta-adrenergic blockers, and all other psychotropic medications were prescribed for less than 10 percent of patients.

In addition to providing pain relief, opiates are potent antianxiety medications in animal models. Also, opiates may prevent memory consolidation (the process by which recent memories are crystallized into vivid long-term memories) through beta-adrenergic mechanisms. Adequate levels of opiate pain control have been associated with development of lower PTSD symptoms levels among children who have survived burn injuries. The researchers conclude that medications with combined analgesic and anxiety-relieving properties may hold promise for prevention of PTSD.

Their study was supported in part by the Agency for Healthcare Research and Quality (HS11372).

More details are in "From bedside to bench: How the epidemiology of clinical practice can inform the secondary prevention of PTSD," by Drs. Zatzick and Roy-Byrne, in the December 2006 Psychiatric Services 57(12), pp. 1726-1730.

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