Injured veterans returning from Iraq and Afghanistan with post-traumatic stress disorder (PTSD) are much more likely to be prescribed opiate painkillers than other vets with chronic pain, according to a new study by researchers at the San Francisco VA Center and the University of California, San Francisco. Veterans who were prescribed opioids also have a significantly higher risk of an overdose, suicide and violent injury.
“Many of these veterans with severe chronic pain also have PTSD as a result of the same trauma that caused their physical injuries,” said Karen Seal, MD, MPH, who served as the lead author of the study and is an associate professor of psychiatry and medicine at UCSF. More soldiers are surviving war zone conflicts because of improved body armor and medical care.
The study, which included over 140,000 soldiers who served from 2005 through 2010, is being published in the Journal of the American Medical Association.
Veterans who were diagnosed with PTSD and who receive prescription painkillers, such as OxyContin and Vicodin, were more likely to request higher dosages and more frequent refills. Many were also prescribed sedatives, like Valium. Veterans who were prescribed opiates were more likely to have thoughts of suicide or violent injury episodes, and were more at risk of alcohol and drug abuse. Veterans diagnosed with mental problems were also more likely to develop a dependency.
“The more anxious you are, the more likely you are to be attuned to pain symptoms, which in turn, make you more anxious, which makes the pain worse, so it becomes a vicious cycle,” Dr. Seal explained. She said that veterans with PTSD may require higher doses because they have more intense pain, have lower thresholds of pain or have fewer endorphins, a natural substance produced by the body that helps relieve pain.
“What we need to do now is really individually assess patients and talk to patients about what we know of the risks of opiates, especially in those with mental health problems,” Dr. Seal said. She added that some patients would show the same rate of improvement with physical therapy, counseling or anti-inflammatory medications, rather than with prescribed painkillers.
According to the Centers for Disease Control and Prevention, deaths attributable to prescription drug overdoses have tripled over the past 20 years. In 2008, more than 14,800 people died from prescription drug overdoses, more than the number who overdosed on cocaine and heroin.
“One of the things that we’re trying to do is, if it appears that there may be a risk for unsafe use of opiates, to really bring that up honestly with the patients, and suggest that there may be other alternatives,” Dr. Seal said. “It’s important to be open to alternative ways of treating pain.”
The Veterans Association and the Department of Defense are working to implement guidelines that more fully address pain management and discourage the overuse of painkillers. Dr. Seal says in addition to therapy and anti-inflammatory medications, such as Ibuprofen, veterans should be encouraged to work through pain issues with exercise, relaxation methods and alternative medicine such as acupuncture.