The Impact of Physical Pain on Suicidal Thoughts and Behaviors

A meta-analysis quantifies the association between chronic pain and the spectrum of suicidal behaviors.

Chronic pain affects 100 million Americans and costs the nation up to $635 billion each year in medical treatments and lost productivity, according to a 2011 report by the Institute of Medicine examining chronic pain as a public health problem.1

The depth of the problem was brought into sharp focus last month with a report from Princeton researchers2 showing a unique and startling rise in midlife mortality among white, non-Hispanic Americans driven, in part, by suicides and drug poisonings.

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Just how many of those people are driven to suicide by pain remains unclear — without a note or other evidence, intentional opioid overdose cannot be differentiated from accidental overuse.

Although numerous studies have established a positive association between pain and suicide, the number of different physical pain types, spectrum of suicidal behaviors studied, and variety of study designs make it difficult to know which patients are at greatest risk, Raffaella Calati, PhD, from the University of Montpellier, in Montpellier, France, told Clinical Pain Advisor.

Collaborating with researchers in Morocco and the United States, Dr. Calati and colleagues conducted a meta-analysis to provide a comprehensive overview of the phenomenon, and evaluate the extent to which suicidal thoughts and behaviors differ among individuals with and without physical pain. The analysis appears in the December 2015 Journal of Psychiatric Research.3

Pain Doubles Suicidality Risk

The meta-analysis included 31 studies of suicidality in patients with any type of pain, including headache, back, neck, chest, musculoskeletal, abdominal, and pelvic pain, as well as arthritis, fibromyalgia, and other pain-related conditions.

Three of the studies analyzed lifetime death wish, 11 published studies (and 1 unpublished study) focused on current suicide ideation, 6 reported on patients who engaged in current suicide planning, 9 looked at current suicide attempts, and 8 studied suicide deaths. Some studies looked at more than one suicidal behavior.

Results showed that individuals with physical pain were more likely than those without to show suicidal behavior across the spectrum of suicidality. The risk for lifetime death wish increased by half (odds ratio [OR] = 1.50; 95% confidence interval [CI], 1.19 – 1.88; P = .0005), and risks for current and lifetime suicidal ideation were more than doubled (OR = 2.11 [95% CI, 1.64 – 2.71] and OR = 2.01 [95% CI, 1.91 – 2.12]; P < .00001 for both comparisons).

Physical pain also more than doubled the risks for suicide planning (OR = 2.60; 95% CI, 1.49 – 4.54; P = .0008), current suicide attempts (OR = 2.54; 95% CI, 1.66 – 3.89; P < .00001), and lifetime suicide attempts (OR = 2.15; 95% CI, 1.73 – 2.68; P < .00001). Patients with physical pain were also more likely to die from suicide (OR = 1.34; 95% CI, 1.05 – 1.71; P = .02).