Tobias Moeller-Bertram, M.D.

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 will 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.

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Selected Publications
Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think?  Spine. 32:1249-1256, 2007

Stratmann G, Gambling DR, Moeller-Bertramm T, Stackpole J, Pue AF and Berkowitz J.  A randomized comparison of a five-minute versus fifteen-minute lockout interval for PCEA during labor. Int J Obstet Anesth. 200-207, 2005

Moeller-Bertram T, Kuczkowski KM, Benumof JL. Uneventful epidural labor analgesia in a parturient with immune thrombocytopenic purpura and platelet count of 26,000/mm3 which was unknown preoperatively. J Clin Anesth. 16:5-53, 2004