Chronic Pain May Be a Contributing Factor to Suicide

Chronic pain may represent an important contributing factor to suicide.

Chronic pain may represent an important contributing factor to suicide, according to a study published in the Annals of Internal Medicine.

To determine the prevalence of chronic pain among those who die by suicide, researchers conducted a retrospective analysis of data compiled by the National Violent Death Reporting System. A total of 123,181 suicide decedents age ≥10 years from 18 states who died between January 2003 and December 2014 were included in the study. For each individual, several aspects relevant to their death were reviewed, including demographic characteristics, toxicology results, precipitating circumstances, and suicide planning and intent.

Of 123,181 individuals, 10,789 (8.8%) showed evidence of chronic pain, with 7.4% and 10.2% of suicide decedents with chronic pain in 2003 and 2014, respectively. Firearm-related injuries (53.6%) and opioid overdose (16.2%) were the main causes of deaths in suicide decedents with chronic pain. The most common categories of chronic pain in suicide decedents were spine pain (24.4%) and musculoskeletal pain (20.8%), and the most common conditions were back pain (22.6%), cancer (12.5%), and arthritis (7.9%). Suicide rates were found to increase with age and were highest in individuals ≥80 years. Men were more affected than women, representing 68.1% of suicide decedents with chronic pain in this cohort. Of these, 27.1% had served in the military and 51.7% of suicide decedents with chronic pain had a known medical condition compared with 44.1% of those without chronic pain. Depression was the most common precipitating factor in both groups, with a diagnosis for the condition in 81.9% and 74.6% of suicide decedents with and without chronic pain, respectively.

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Study limitations include a possible underrepresentation of the true percentage of suicide decedents with chronic pain.

“Providers caring for patients with chronic pain should be aware of the potential increased risk for suicide, and more effort may be needed to diagnose, manage, and treat chronic pain and comorbid mental health conditions,” concluded the study authors.


Petrosky E, Harpaz R, Fowler KA, et al. Chronic pain among suicide decedents, 2003 to 2014: Findings from the national violent death reporting system. Ann Intern Med. 2018;169:448-455.