Even Moderate Pain Associated With Suicide Risk

Moderate, Severe Chronic Pain May Be Associated With Suicide Risk in Veterans – Clinical Pain AdvisorBrandon May – Mar 2019

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.

5 thoughts on “Even Moderate Pain Associated With Suicide Risk

  1. Karen Messinger

    Does it surprise anyone who has pain or anyone who watches their loved ones forced to live with pain that is not controlled? Our vets have things to deal with but untreated pain & being forced to live with it by the very govt they served is just plain wrong. Our vets were the first ones to be forced to live with pain, enough pain 24/7 to make suicide an alternative. Took away their PTSD med too.

    Liked by 1 person

  2. Kathy C

    The VA used to have standards, now they just gas light their patients. I have friends they have put through the worst kind of denial of care. I am really concerned about one in particular right now, but I have serious reservations about contacting anyone. In my community they are always claiming they are “supporting our vets” but the opposite is true.

    I came across this today, it looks like a little family practitioner is peddling the CDC guidelines, which led to more suicides and deaths. He is available for corporate functions for a speaking fee. He is looking to make a buck from suicide prevention week. Nothing is off limits for marketing.



    1. Zyp Czyk Post author

      You’re right, “supporting our vets” is a complete empty phrase as we take away their pain meds – the medication they need to continue being “survivors” of military action.


    1. Zyp Czyk Post author

      And the judgement depends on who’s being asked. The patient might say severe, but the doctor can just believe (and write in the patient’s medical record) that it’s only moderate. What the doctors believe is all that really matters to anyone except the poor patients.

      Liked by 1 person


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