Risk for suicidal ideation among those with chronic pain may be influenced by their level of pain acceptance, according to study findings published in Pain Medicine.
Investigators from the University of Texas at San Antonio sought to test the hypothesis that greater pain acceptance mitigated the relationship between pain severity, its perceived burden, and suicidal ideation.
The investigators recruited participants with a chronic pain condition lasting at least 4 months via advertisements at 3 clinics on military bases in the Southwestern US. Study participants (n=207) completed a questionnaire that included multiple pain and suicidal ideation instruments.
The study participants were mostly active-duty military (64.5%); 56.1% were men, 68% were married. Of the participants, 24.9% had pain that was work-related, 20% had a non-work-related injury, 25.9% had low back pain, 15.4% had lower extremity pain, and 14.0% had multi-site pain. The average duration of pain was 3.84 years, and 32.7% of participants had undergone surgery for their pain condition.
A significant relationship was observed between pain severity and suicidal ideation (b, 3.41; P <.001), which was highly mediated by perceived burdensomeness (b, 3.04; P <.001). Perceived burdensomeness in turn significantly predicted suicidal ideation (b, 1.01; P <.001). The overall indirect effect mediated 89.31% of the total effects (b, 3.05; P <.001). After accounting for the significant indirect effect, there was no direct effect of pain severity on suicidal ideation.
Pain acceptance moderated the relationship between pain severity and perceived burdensomeness (b, -0.59; P =.008) and accounted for an additional 4.4% of variance. The relationship between pain severity and perceived burdensomeness was only significant among the subset of participants (68.32%) with pain acceptance scores below 75.40 points. This cutoff indicated that among individuals with low or moderate acceptance of their pain, the burden level they attached to that pain was correlated with pain severity.
Similarly, pain acceptance moderated the relationship between perceived burdensomeness and suicidal ideation (b, -2.34; P =.02) and accounted for an additional 2.5% of variance. This relationship was only significant among the subset of participants (84.05%) with pain acceptance scores below 86.50 points, indicating that the relationship was more pronounced among those with less pain acceptance.
In the full conditional process model, significant indirect effects were observed among individuals with low (b, 2.50; P =.001) and medium (b, 0.99; P =.010) levels of pain acceptance but not high acceptance (b, 0.08; P =.679).
A limitation of this study is that findings may not be generalizable for the entire pain population, as participants were recruited from military bases.
The study authors concluded, “Our results highlight how pain acceptance may short-circuit the relationship between pain severity and perceived burdensomeness.” They further added that “Findings indicate that any improvement in pain acceptance can be beneficial, and they provide clinicians with a clinical cut-point that may indicate lower vs. higher suicide risk.”
Hale W, Vacek S, Crabtree M, et al. The benefits of making peace with pain: chronic pain acceptance moderates the indirect effect of perceived burdensomeness between pain severity and suicidal cognitions. Pain Med. 2023;pnad042. doi:10.1093/pm/pnad042