Although the findings confirm what is known, coalescing the data into a single analysis provides clinicians and researchers a quick reference summary, according to Jennifer Brennan Braden, MD, psychiatrist and affiliate assistant professor at the University of Washington, Seattle. Dr. Braden specializes in pain and was lead author of a study included in the meta-analysis.

“What is nice about this paper is that they have brought all these different research studies together and given an odds ratio for different aspects of suicidality along the continuum,” Dr. Braden told Clinical Pain Advisor. “I think it is nice to be able to look at that, and in particular to see that there is an increased risk for each of those areas along the continuum.”

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The authors cite the heterogeneity of the studies as a limitation of their analysis, and suggest that future research focus more on specific pain types and the contributions of neural systems of physical and social/psychological pain.

“Further research should more closely focus on specific risk factors for suicide in chronic pain patients. For example, type, severity and duration of pain; access to analgesics; helplessness and hopelessness about pain,” Dr. Calati said. “Concerning pain type, the relationship between specific pain conditions (medically unexplained pain) and suicide should be better dissected.”

Screening Recommended

According to Dr. Calati, the analysis underscores the importance of screening pain patients for suicidality.

“The main take-away message of our paper is that clinicians treating patients with pain should be aware of the increased suicide risk, and always carefully monitor suicidal thoughts and plans and lifetime suicide attempts in these patients,” Dr. Calati said, noting that doing so may help diminish suicidal risk.

Dr. Braden concurs, but points out that other factors may also play a role in suicide.

“One thing we do know about suicide in general is that over 90% of suicide victims have a diagnosable psychiatric illness, most commonly a mood disorder. Hence, providers need to routinely screen for and treat depression in these patients,” Dr. Braden concluded.

References

1. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. Washington (DC): National Academies Press (US); 2011.

2. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. PNAS. 2015; published ahead of print November 2, 2015. doi:10.1073/pnas.1518393112

3. Calati R, Laglaoui Bakhiyi C, Artero S, Ilgen M, Courtet P. The impact of physical pain on suicidal thoughts and behaviors: Meta-analyses. J Psychiatr Res. 2015 Dec;71:16-32. doi:10.1016/j.jpsychires.2015.09.004. Epub 2015 Sep 11. Review.