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There is clear evidence that an overwhelming stressor can induce lasting pathological changes in the body’s stress response including the hypothalamic-pituitary adrenal axis as well as the sympathetic nervous system and the immune system. In susceptible individuals such a stressor can induce Post Traumatic Stress Disorder (PTSD). Altered pain thresholds and high co-morbidity of pain and chronic pain syndromes has been shown in PTSD in multiple publications. Increased levels of SP and IL-6 in cerebrospinal fluid of PTSD subjects have been found. This means that we now have objective quantifiable measures of physiological parameters in PTSD patients. Using QST testing, Dr. Moeller-Bertram found evidence for increased central sensitization in PTSD subjects compared to controls. But little is known about the mechanisms connecting altered stress systems and pain. Studies in this lab utilize the intramuscular pain model established by Dr. Wallace to measure the evoked pain response in subjects with combat related Post Traumatic Stress Disorder in comparison to controls. Evaluations include simultaneous QST testing in response to peripheral stimulation, longitudinal CSF collection for neurotransmitter measurements and fMRI utilization targeting areas of overlap for PTSD and the pain circuit. In collaboration with other members of the training grant (Drs. Patel, Yaksh, Roth and Schulteis), a rodent model of PTSD and pain testing is in process of being developed which will allow for the same evaluations, QST testing, CSF measurements and fMRI evaluation to further elucidate underlying mechanisms.
References (Selected From 13 Publications)
Moeller-Bertram T, Wallace MS: Fixed and flexible dosing of pregabalin for postherpetic neuralgia: Comparing tolerability and onset of pain relief. Clinical Trials Report for the Neuropathic Pain section of Curr Pain and Headache Rep, 13 (3): 179-180, 2009.
Dawley JD, Moeller-Bertram T, Wallace WS, Patel PM. Intra-arterial injection in the rat brain: evaluation of steroids used for transforaminal epidurals. Spine J, 15:1638-43, 2009.
Afari N, Harder L, Heppner P, Moeller-Bertram T, Madra NJ, Orcutt JL & Baker DG. PTSD, Combat Injury, and Headache In Veterans Returning From Iraq/Afghanistan. Headache, 49(9):1267-76, 2009.
Moeller-Bertram T, Kuczkowski KM, Benumof JL: Uneventful Epidural Labor Analgesia in a Parturient with Immune Thrombocytopenic Purpura and Platelet Count of 26,000/mm“ Unknown Preoperatively. J Clin Anesth., 16: 51-53, 2004.