Moderate, Severe Chronic Pain May Be Associated With Suicide Risk in Veterans

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Pain intensity may represent a reliable indicator of suicide risk in veterans.

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); in particular, data on demographics, suicide attempts, psychiatric and medical diagnoses, opioid prescriptions, and pain specialty service visits were included in the analysis. 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 between suicide attempts and 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. 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.

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Limitations of the analysis include the potential for underreported suicide attempts and a lack of data on lifetime suicide attempts, which may contribute to an increased risk for further attempts.

“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.”

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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