An unusual reaction to opioid blockade with naltrexone in a case of post‐traumatic stress disorder

Ibarra, Paloma; Bruehl, Stephen; Carlson, Charles R.; Wilson, John F.; Norton, Jane A.; McCubbin, James A.; Montgomery, Thomas B.

doi:10.1002/jts.2490070210

Cited by 24 publications

(10 citation statements)

References 9 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are also data suggesting that startle responses are intensified during states of negative affect (25), to which both conditions can be a major contributor (26). Further, preliminary data suggest that stress responses and pain modulation are dysregulated in both conditions (27,28). Collectively, these findings indicate that PTSD and chronic pain share similar response patterns in the cognitive, behavioural, and physiological domains; in the opinion of some (3,29), the data suggest an intricate connection between the 2 conditions.…”

Section: Symptom Overlapmentioning

confidence: 80%

PTSD and the Experience of Pain: Research and Clinical Implications of Shared Vulnerability and Mutual Maintenance Models

et al. 2002

View full text Add to dashboard Cite

I t is not atypical for patients with posttraumatic stress disorder (PTSD) to present with several concomitant physical and mental health problems. These most often include increased reporting of physical symptoms and physical health problems, increased alcohol consumption, and depressed mood (1,2). Recent evidence suggests that pain is one of the most commonly reported symptoms of patients with PTSD, regardless of the nature of their traumatic experience (for example, military combat, motor vehicle accident, or sexual assault). Similarly, patients who have persistent, chronic pain associated with musculoskeletal injury, serious burn injuries, and other pathologies (such as fibromyalgia, cancer, or AIDS) frequently present with symptoms of PTSD. In the past decade, investigation into the relation(s) between PTSD and the experience of pain has flourished. To a lesser degree, researchers have developed models that attempt to explain how the conditions may be linked (3). This paper has several purposes. First, we provide summary definitions of the conditions under discussion. Second, we highlight symptoms from each condition that have similar characteristics. Third, we summarize the literature on prevalence rates of pain experiences in PTSD populations, and vice versa. Fourth, we articulate potential explanations for the observed association between pain and PTSD. Finally, we discuss future directions for empirical investigation and clinical practice that stem from this line of inquiry. Clinical Implications· Clinicians treating patients with posttraumatic stress disorder (PTSD) need to pay careful attention to co-occurring symptoms of pain. · Likewise, those treating patients with chronic pain need to be aware of the potential influence of PTSD symptoms on clinical presentation. · Use of propranolol may be effective in simultaneous relief of co-occurring PTSD and pain symptoms. Limitation · The positions suggested in this review warrant careful empirical scrutiny.It is common for individuals with symptoms of posttraumatic stress disorder (PTSD) to present with cooccurring pain problems, and vice versa. However, the relation between these conditions often goes unrecognized in clinical settings. In this paper, we describe potential relations between PTSD and chronic pain and their implications for assessment and treatment. To accomplish this, we discuss phenomenological similarities of these conditions, the prevalence of chronic pain in patients with PTSD, and the prevalence of PTSD in patients with chronic pain. We also present several possible explanations for the co-occurrence of these disorders, based primarily on the notions of shared vulnerability and mutual maintenance. The paper concludes with an overview of future research directions, as well as practical recommendations for assessing and treating patients who present with co-occurring PTSD or chronic pain symptoms.

show abstract

Section: Symptom Overlapmentioning

confidence: 80%

PTSD and the Experience of Pain: Research and Clinical Implications of Shared Vulnerability and Mutual Maintenance Models

et al. 2002

View full text Add to dashboard Cite

show abstract

“…The proposed mechanism of excessive pain occurrence could have treatment implications, as it implies prophylactic use of opioid receptor antagonists. Indeed, on the basis of the hypothesis that opioidergic mechanisms are involved in the pathophysiology and symptoms of PTSD 146, 154, 155 , opioid antagonists have been evaluated for a potential clinical efficacy in a number of clinical trials 147, 156, 157 . On the whole, they were safe and well tolerated and resulted in significant improvements of various aspects of PTSD symtomatology such as emotional numbing, startle response, nightmares, flashbacks, intrusive thoughts and comorbid alcoholism 147, 156, 158 .…”

Section: Co-morbidity Of Pain and Psychiatric Disordersmentioning

confidence: 99%

The Missing P in Psychiatric Training

Elman¹,

Zubieta²,

Borsook³

2011

Arch Gen Psychiatry

105

View full text Add to dashboard Cite

Context Pain problems are exceedingly prevalent among psychiatric patients. Moreover, clinical impressions and neurobiological research suggest that physical and psychological aspects of pain are closely related entities. Nonetheless, remarkably few pain-related themes are presently included in psychiatric residency training. Objective Our objective is twofold: (1) to provide clinical and scientific rationale for psychiatric training enrichment with basic tenets of pain medicine and (2) to raise the awareness and sensitivity of clinicians, scientists and educators alike to the important yet unmet clinical and public health need. Results Three lines of translational research evidence, extracted from the comprehensive literature review, are presented in support of the objective. First, the neuroanatomical and functional overlap between pain and emotion/reward/motivation brain circuits suggests integration and mutual modulation of these systems. Second, psychiatric disorders are commonly associated with alterations in pain processing, whereas chronic pain may impair emotional and neurocognitive functioning. Third, pain may serve as a functional probe for unraveling pathophysiological mechanisms inherent in psychiatric morbidity given its stressful nature for the organism. Conclusions Pain training in psychiatry will not only contribute to deeper and more sophisticated insights into pain syndromes but also into psychiatric morbidity at large regardless of patients’ pain status. Furthermore, it will ease artificial boundaries separating psychiatric and medical formulations of brain disorders, thus fostering cross-fertilizing interactions between specialists in various disciplines entrusted with the care of pain patients.

show abstract

“…-My attitude has changed quite a bit from a killing mode to a more passionate, calm individual." Ibarra et al (1994) also described how the same veteran in their study lost his depth perception and experienced the image of his wife as two dimensional. A veteran on the nalmefene pilot study (veteran H) experienced a similar symptom.…”

Section: Hillel Glover1mentioning

confidence: 92%

“…Ibarra et al (1994) provided an historical perspective regarding studies of opioid mechanisms in PTSD and the use of opiate antagonists. A study by Pitman, van der Kolk, Orr, and Greenberg (1990) was cited, but the more relevant, second report of that same study, "Endogenous Opioids, Stress Induced Analgesia, and Posttraumatic Stress Disorder," by the same authors (van der Kolk, Greenberg, Orr, & Pitman, 1989) was overlooked.…”

Section: Hillel Glover1mentioning

confidence: 99%

See 1 more Smart Citation

A Different opinion regarding the use of opiate antagonists in PTSD: Comments on “an unusual reaction to opioid blockade with naltrexone in a case of post‐traumatic stress disorder”

Glover

1995

Journal of Traumatic Stress

View full text Add to dashboard Cite

show abstract

An unusual reaction to opioid blockade with naltrexone in a case of post‐traumatic stress disorder

Cited by 24 publications

References 9 publications

PTSD and the Experience of Pain: Research and Clinical Implications of Shared Vulnerability and Mutual Maintenance Models

PTSD and the Experience of Pain: Research and Clinical Implications of Shared Vulnerability and Mutual Maintenance Models

The Missing P in Psychiatric Training

A Different opinion regarding the use of opiate antagonists in PTSD: Comments on “an unusual reaction to opioid blockade with naltrexone in a case of post‐traumatic stress disorder”

Contact Info

Product

Resources

About