The possible effect of fentanyl on PTSD.

Abstract

Post-traumatic stress disorder (PTSD) is a severe mental health disorder that appears as a result of trauma exposure and adversely affects the daily life and well-being of those who suffer from it. Major risk factors for PTSD include serving as a combat soldier and having traumatic and painful injuries. This review aims to investigate the possible beneficial effects of fentanyl on PTSD, and the possible theoretical mechanisms at the base of these effects. Fentanyl is a powerful analgesic from the opioid family that is often administered in cases of painful injuries, both as a prehospital battlefield treatment and at the hospital. Morphine, another opioid used for analgesia in similar situations, was shown to help both with the prevention and treatment of PTSD. Only a few studies examine the direct influence of fentanyl on PTSD, but there is evidence that indirectly suggests that fentanyl can treat or prevent PTSD via three mediating factors. In this review we suggest three possible hypotheses. In one possible route, the influence of fentanyl on PTSD is mediated by pain relief. Fentanyl was found to effectively reduce pain, and a positive correlation between pain level and PTSD severity was also found. The second route suggests that fentanyl's influence on PTSD is mediated by the activity of the vagus nerve. There is evidence that fentanyl administration results in vagal activity and that the activation of the vagus nerve reduces PTSD levels. A third possible route may be through fentanyl's activation of opioid receptors in limbic region which were found to have protective effects against PTSD. Future research of fentanyl's role in PTSD prevention and treatment is essential, and should account for pre-existing mental health struggles, TBI, delirium, and injury severity.