Chronic, Noncancer Pain Boosts Suicide Risk

Chronic, Noncancer Pain Boosts Suicide Risk

Certain types of noncancer pain conditions are associated with an increased risk for suicide, a new study suggests.

psychogenic pain, back pain, and migraine, but not arthritis or neuropathy, were associated with an increased risk for suicide.

As any pain patient, I find the concept of “psychogenic pain” to be unscientific, vague, and insulting to those of us who suffered for years from undiagnosed – not psychogenic – pain.  Dr Ilgen seems to agree in his comments at the end.

Although some of this risk appears to be due to co-occurring mental health problems, there may be something about the experience of pain that also contributes directly to suicide risk, [Does it take a study to make this obvious? -ed.]

individuals with pain may be at increased risk for suicidal thoughts and behaviors, but it is likely that “not all pain is created equal” in terms of its association with suicide, and that the association between pain and suicide could vary, depending on the type of pain patients experience

Psychogenic pain was associated with the greatest risk for suicide death (hazard ratio [HR], 2.61; 95% confidence interval [CI], 1.82 – 3.74).

“Psychogenic pain is listed within the ICD-9 [International Classification of Diseases, Ninth Revision] coding system and characterizes pain that is caused by psychological instead of purely physical factors,” Dr. Ilgen explained.

“This is a diagnosis that is used relatively infrequently within the VA, and there is considerable disagreement among pain and mental health professionals about the validity and utility of this diagnosis,”

“Because of the type of data that were analyzed in this study, it is impossible to tell what treatment providers were thinking when they used the diagnosis of psychogenic pain”

Below, Dr. Ilgen states exactly what is wrong with the diagnosis of psychogenic pain:

“Still, this diagnosis had the strongest association with suicide of any of the pain disorders that we examined. It is my guess that a diagnosis of psychogenic pain is given to patients with pain that is poorly understood and that may be particularly difficult to treat. Also, there is the possibility that patients with this diagnosis are particularly frustrated with their care and hopeless about the resolution of their pain condition. I do not interpret our findings to indicate that ‘psychogenic pain,’ as it is defined in the ICD-9, is directly causing suicide, rather, that there is something about being diagnosed with this condition that is associated with a particularly poor prognosis.”

the “take-home message” is that clinicians should be evaluating suicide risk in all patients with pain

Also, asking about pain is not enough. Clinicians should make sure that patients with pain are getting appropriate treatment, she added

This is saying that even if doctors don’t know the cause of pain, it should be treated.