Pain intensity may represent a reliable indicator of suicide risk in veterans, according to a study published in the Journal of Pain.
The data of veterans who used Veterans Health Administration pain specialty services (index visit) between 2012 and 2014 were analyzed (n=221,817);
Medical records and suicide surveillance sources were used to identify suicide attempts in the year following the initiation of pain services.
Comparisons were performed in veterans with and without suicide attempts in the year before the index visit to assess the risk for first attempt and re-attempts.
Approximately 1% of the cohort had attempted suicide during the study period, with a post-index visit suicide attempt rate of 1023/100,000 person-years
Suicide risk was associated with reporting of
- severe (hazards ratio [HR], 1.41; 95% CI, 1.21-1.63) and
- moderate pain intensity (HR, 1.29; 95% CI, 1.13-1.47).
Similar associations betweensuicide attemptsand
- severe pain (HR, 1.41; 95% CI, 1.21-1.63) and
- moderate pain (HR, 1.29; 95% CI, 1.14-1.47)
were established in an adjusted analysis.
These numbers are virtually identical for suicide risk and attempt, making it look like they did nothing for the veterans with a suicide risk so that they all made suicide attempts. Or, did the researchers simply count attempts and convert them into risks?
In veterans with no suicide attempt in the year before the index visit, severe (HR, 1.39; 95% CI, 1.18-1.63) and moderate pain (HR, 1.26; 95% CI, 1.09-1.46) were found to be associated with an increased risk for suicide attempt in the year after the index visit.
“The pain intensity-suicidal behavior link highlights the importance of behavioral health provider’s consideration of the psychosocial aspects of pain and pain providers recognizing the potential lethality of pain and its associated behavioral health problems,” the researchers noted.
“In pain treatment settings, increases in pain intensity may pose opportunities to assess suicide risk and implement safety procedures.”
Ashrafioun L, Kane C, Bishop TM, Britton PC, Pigeon WR. The association of pain intensity and suicide attempts among patients initiating pain specialty services [published online January 25, 2019]. J Pain. doi:10.1016/j.jpain.2019.01.012
Full text of reference study abstract below:
Using Veterans Health Administration data, we assessed the extent to which mean past-year (365 days) pain intensity scores were associated with suicide attempts in the year after the initiation of pain specialty services in fiscal years 2012 to 2014 (N = 221,817).
Suicide attempts in the year after initiating Veterans Health Administration pain specialty services (ie, index visit) were identified using medical records and a suicide surveillance sources.
Adjusted hazard models accounted for key covariates (eg, demographics, comorbidities). Subgroup analyses were also conducted on veterans without and with a suicide attempt in the year before the index visit to examine risk for first attempt and reattempts.
Adjusted analyses revealed that pain intensity scores were significantly associated suicide attempts after the index visit.
Specifically, veterans with severe and moderate pain had a hazards ratio of 1.41 (95% confidence interval = 1.21-1.63) and 1.29 (95% confidence interval = 1.13-1.47), respectively.
These results were consistent for those without a past-year attempt and for those with a past-year attempt.
The results suggest that moderate to severe pain intensity in the year before initiating pain specialty services may be a useful indicator of suicide risk, even when considered in the context of key factors.