December 2017

11th – 25th December

Ketamine Administration for Chronic Pain and Suicide

In the US, the suicide rate is reportedly increasing, with growing incidents in the younger population. Male veterans exhibit a higher rate of suicide than their non-veteran counterparts (32.1 vs 20.9 per 100,000), with this discrepancy even larger for female veterans vs non-veterans (28.7 vs 5.2 per 100,000). Chronic pain is thought of as a contributing factor to some of these suicide cases, possibly due to the associated comorbidities that often accompany chronic pain conditions. Unfortunately, these complex diagnoses make it more difficult to treat and manage symptoms with the health care system often stretched to meet the required needs.

 Ketamine has been previously identified as a possible medication for cases where chronic pain, mental health and suicide ideation are present. It is a potent therapeutic option that has a rapid onset and a reasonable side effect profile, if administration is managed appropriately. Ketamine may even have long-lasting effects that could benefit veterans in terms of their manageability of depression and suicidal behaviour. The drug has also been demonstrated to have a positive effect on treating chronic pain and PTSD, conditions that often affect veterans.

The pharmacology of ketamine is complex but as a whole it is thought to primarily act as an antagonist at N-Methyl-D-aspartate (NMDA) receptors, meaning that it slows down and inhibits some of the excitatory transmission systems in our bodies. Furthermore, ketamine is a weak agonist at opioid receptors, stimulating greater levels of endogenous opioids that can have a pain relieving effect. Since ketamine is used as an anaesthetic, levels of the drug should be administered at smaller doses and in a controlled manner for significant improvements in mood and anxiety. Studies assessing the effect of ketamine on anxiety, depression and pain have found that all three are alleviated by ketamine administration, with few side effects reported.

Further research is needed in order to confirm the suitability of ketamine as an effective, long-term medication for the array of ailments veterans are often inflicted by (anxiety, pain, depression, PTSD and suicide ideation) but current studies provide reassuring data that this could be a breakthrough drug in helping to treat comorbid mental health and chronic pain diagnoses.

The article can be accessed here.

Acupuncture and Tackling Opioid Dependence

Researchers from the American TCM Association, USA, have suggested using acupuncture as an effective, non-pharmacological strategy for pain reduction. Non-pharmacological pain treatments are important considerations when attempting to tackle opioid dependence since pain medications can often be a contributing factor. Furthermore, acupuncture is a cost effective treatment that has numerous studies backing its success at reducing and managing pain. The strongest evidence suggests acupuncture is most beneficial for back pain, neck pain, shoulder pain, chronic headache and osteoarthritis. Acupuncture is thought to work by stimulating the natural release of endogenous opioids in humans. It has already being successfully used in the United States as a way of decreasing the need for pharmacological opioid prescriptions and due to its safety and ease of administration it can be readily provided at hospitals and medical centres. Further longitudinal studies analysing acupuncture as a suitable alternative to opioid medication will help clarify the effectiveness of this treatment and its long-term benefits. These findings will help contribute towards appropriate support for military veterans; however, additional factors will need to be considered since veterans often suffer with comorbidities alongside their chronic pain.

The review article can be accessed here.

Student Veterans Reintegrating into University Life

A study from The University of North Carolina investigated whether student veterans were able to reintegrate into University life and whether campus services were meeting the students’ appropriate health needs.  One hundred and twenty seven student veterans completed questionnaires regarding their experiences of University life following military service. The results revealed that 92.7% of student veterans reported that their chronic pain interfered with their daily functioning. Other symptoms that also had an impact on everyday living were PTSD (77.9%) and traumatic brain injury (26.0%). Although these percentages are high, few people accessed disability services, counselling services or student health services (36.5%). These findings indicated the need for a more military focused campus services that can address the particular needs of the student veterans. Another aspect is correctly targeting these students and offering support where appropriate in order to better help veterans to cope with their injuries whilst at University.

The abstract for this research article can be found here.

4th – 10th December

APOE Gene and PTSD Resilience

Researchers from The Department of Clinical Health Psychology, University of Manitoba, Canada, recently published an article examining the possible link between the Apolipoprotein E (APOE) gene and PTSD, in the journal Depression and Anxiety. Previous studies have tried to identify possible genetic risk factors for PTSD including investigating how APOE may contribute to risk or resilience. Unfortunately, these studies have been carried out with small sample sizes and have failed to reach a conclusion regarding the potential relationship between APOE and PTSD.  The APOE gene encodes the APOE protein that plays a role in various biological functions, such as neuronal repair and cholesterol transportation. The gene can be found in the human body in 3 functionally different forms (or alleles) called e2, e3 and e4. APOE e4 has recently been linked to a higher likelihood of Alzheimer’s disease.

The current study used a large, representative sample size of 1,386 trauma exposed military veterans. Participants provided saliva samples for DNA extraction to determine APOE e4 carriers. Other demographic details were gathered such as age, gender and the number of years of military service and PTSD symptomology was also assessed. Results indicated that APOE e4 carriers were more likely to report greater lifetime and past-month PTSD symptoms than non-carriers, suggesting an association between e4 carrier status and higher risk of combat-related PTSD. It may be that the e4 allele is unable to provide adequate neuronal repair following stress-induced injury. Interestingly, those e4 carriers who had a supportive social network showed more resilience to PTSD than those e4 carriers who did not report receiving social support. Further research is necessary to elucidate the relationship between APOE e4, PTSD and dementia likelihood.

A summary of the article can be found here.

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