Patients With Chronic Pain Are Twice as Likely to Attempt Suicide

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Sleep-onset insomnia, pain intensity, and daytime dysfunction contribute to risk of suicide in patients diagnosed with chronic pain.
Sleep-onset insomnia, pain intensity, and daytime dysfunction contribute to risk of suicide in patients diagnosed with chronic pain.

LAS VEGAS — Patients with chronic pain are vulnerable to depression and may present with higher risk for suicide, according to findings from a literature review presented at PAINWeek 2017.1 Integration of mental health assessment during the diagnosis and treatment of chronic pain may be clinically important for reducing risk in this patient population.

In 2014, suicide ranked as the 10th most frequent cause of death.2 Patients with chronic pain are twice as likely to attempt suicide compared with those without chronic pain, an action generally caused by a myriad of associated psychological, physical, and social factors.3 A questionnaire survey of 1512 patients with chronic pain found that 32% reported suicide ideation in some degree.4 

According to findings from a PubMed database search for the terms “chronic pain + suicide,” Drs Joseph Pergolizzi, Jr, et al found that chronic (but not acute) pain may share neural networks with depression. According to the investigators, “This shared neurobiology may explain why cognitive behavioral interventions can be effective in chronic pain patients.” 

Chronic pain affects cognition and behavior and may ultimately lead to social isolation, contributing to depression.5 Risk factors and predisposing factors associated with suicidal risk in patients with chronic pain include biochemical and neurochemical influences, genetics, psychosocial events, and environment, according to the researchers' findings. 

One of the risk factors for suicide in patients diagnosed with chronic pain, according to the study, is sleep-onset insomnia as well as daytime dysfunction and high pain intensity. The researchers identified these as important prognostic risk factors for suicide among patients with chronic pain, even more so than depression itself. 

Additionally, the investigators note that clinicians should understand that the risks for suicide among patients with chronic pain are multifactorial, typically stemming from underlying psychological and neurological challenges that go beyond the physical manifestation of pain. 

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References

  1. Pergolizzi J, Jr, Raffa R, Taylor R Jr, et al. The risk of suicide risk in chronic pain patients. Presented at: PAINWeek 2017. Las Vegas, NV; September 5-9, 2017. Poster 48.
  2. Suicide Statistics. American Foundation for Suicide Prevention website. https://afsp.org/about-suicide/suicide-statistics/. Accessed October 2, 2017.
  3. Lee DH, Noh EC, Kim YC, et al. Risk factors for suicidal ideation among patients with complex regional pain syndrome. Psychiatry Investig. 2014;11(1):32-38.
  4. Edwards RR, Smith MT, Kudel I, Haythornthwaite J. Pain-related catastrophizing as a risk factor for suicidal ideation in chronic pain. Pain. 2006;126(1-3):272-279.
  5. Nekovarova T, Yamamotova A, Vales K, et al. Common mechanisms of pain and depression: are antidepressants also analgesics? Front Behav Neurosci. 2014;8:99.
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