Chronic pain and suicide risk: A comprehensive review

Chronic pain and suicide risk: A comprehensive review. – PubMed – NCBI – Prog Neuropsychopharmacol Biol Psychiatry. 2017 Aug

Death by suicide is one of the leading causes of mortality worldwide.

Because individuals with chronic pain are at least twice as likely to report suicidal behaviors or to complete suicide, it is of utmost importance to target which risk factors contribute the most to increasing suicidality.

This comprehensive review aims to provide an update on research advancements relating to the identification of potential risk factors for suicidality in individuals with chronic pain.  

Supporting the results of prior reviews, we found robust evidence that chronic pain itself, regardless of type, was an important independent risk factor for suicidality.

The only sociodemographic factor found to be associated with suicidality in individuals with chronic pain was being unemployed/disabled.

• Depressive symptoms,
• anger problems,
• harmful habits (e.g. smoking, alcohol misuse, illicit drugs),
• childhood or adulthood adversities, and
• family history of depression/suicide

were all also identified as general risk factors.

Regarding pain-related factors,

• sleep problems,
• poorer perceived mental health,
• concurrent chronic pain conditions, and
• more frequent episodes of intermittent pain,

were all found to be predictors of suicidality.

Unexpectedly, pain characteristics (e.g. type, duration, and intensity/severity) and physical status (e.g. pain interference or disability) were not related to suicide risk.

We also identified promising new psychosocial factors

• (e.g.  mental defeat,
• pain catastrophizing,
• hopelessness,
• perceived burdensomeness and
• thwarted belongingness)

associated with suicidality outcomes.

All these factors are triggered when a long-time pain patient successfully maintained on opioid therapy is unilaterally, suddenly, and forcefully tapered off their pain medication,

How can they feel anything but defeat and hopelessness? How is this NOT a catastrophe?

Without pain relief, these patients know they will become a burden to their loved ones.

Having our pain relief government-mandated and impersonally denied makes it more than clear that we are not wanted in society.

I feel utterly rejected by a society that simply doesn’t care about my suffering and even insists it is not so:

Society believes that I’m not really suffering,
that I only think that I’m suffering.

That used to be called a “mind-f*ck”, when someone in authority tells you how you are feeling, invalidating your own perceptions.

Now it’s called catastrophizing, when doctors and researchers tell us the despair we feel about our painful lives isn’t really a catastrophe, that we only think it is.

A large number of these factors are amenable to change through targeted intervention, highlighting the importance of comprehensively assessing chronic pain patients at risk for suicide, while also incorporating a suicide prevention component into chronic pain management programs.

Original article: Chronic pain and suicide risk: A comprehensive review