Chronic pain was prevalent in nearly 9% of individuals who died by suicide, according to research published in Annals of Internal Medicine.
“More than 25 million adults in the United States have chronic pain,” Emiko Petrosky, MD, MPH, from the CDC, and colleagues wrote. “Chronic pain has been associated with suicidality, but previous studies primarily examined nonfatal suicidal behaviors rather than suicide deaths associated with chronic pain or the characteristics of such deaths.”
Petrosky and colleagues analyzed data from the National Violent Death Reporting System (NVDRS) to determine the prevalence of chronic pain among suicide decedents. The researchers identified the characteristics and circumstances that directly contributed to suicides.
A total of 123,181 suicide decedents with and without chronic pain died between Jan. 1, 2003 and Dec. 31, 2014. The researchers examined participants’ demographic characteristics; mechanism of death; toxicology results; precipitating circumstances, such as mental health, substance use, interpersonal problems and/or life stressors; and suicide planning and intent.
Results indicated that 8.8% (n = 10,789) of suicide decedents had chronic pain. The proportion of suicide decedents increased from 7.4% to 10.2% over the study period. About 54% of suicide decedents with chronic pain died of firearm-related injuries, whereas 16.2% died by opioid overdose.
Spine pain (24.4%) and musculoskeletal pain (20.8%) were the most commonly reported categories of pain and back pain (22.6%), cancer (12.5%) and arthritis (7.9%) were the most commonly reported conditions of pain.
“Health care providers caring for patients with chronic pain should be aware of the potential risk for suicide,” Petrosky told Healio Internal Medicine. “Screening for depression and suicidal thoughts or intent among patients with chronic pain could potentially help health care providers identify patients who need resources and support to prevent suicide.”
Petrosky alluded to a recent study which found that believing that there is a medical cure for pain can protect against suicidal ideation; therefore, she said, it is important to improve access to quality, comprehensive pain care, adherence to best opioid prescribing practices and integration of primary care, mental health care and pain medicine.
According to the CDC, improving economic supports, improving suicide care and creating protective environments may help prevent patient suicide, she said.
“Although we did not examine health care systems in our study, there are steps these systems can take to prevent suicide, including providing high-quality, ongoing care focused on patient safety and suicide prevention, making sure affordable and effective mental and physical health care is available where people live and training providers in adopting proven treatments for patients at risk of suicide,” Petrosky said.
Clinicians should be aware of warning signs for suicide in patient interactions, including comments such as “feeling like a burden,” being isolated, increased anxiety, feeling trapped or in unbearable pain, increased substance use, looking for a way to access lethal means, increased anger or rage, extreme mood swings, expressing hopelessness, sleeping too little or too much, talking or posting about wanting to die and making plans for suicide, according to Petrosky.
She noted that patients should contact the National Suicide Prevention Lifeline Talk (1-800-273-8255) or visit www.suicidepreventionlifeline.org if they are contemplating suicide. Other helpful resources for clinicians and their patients include the National Action Alliance for Suicide Prevention, Zero Suicide in Health and Behavioral Healthcare, CDC training tools for providers and CDC patient materials, she said.
In an accompanying editorial, Mark Ilgen, PhD, from the University of Michigan, wrote that the study by Petrosky and colleagues builds upon existing evidence that many suicides occur among individuals with chronic pain.
“Suicide prevention involves making effective pain interventions more available, which extends beyond providing access to opioids and should also include, if appropriate, other medications, interventional programs, physical therapy, and psychosocial approaches,” he wrote. “These pain-related interventions need to be supplemented with mental health treatment in persons with pain and depressive and anxiety-related symptoms to foster hope and help address suicidal thoughts and plans.” – by Alaina Tedesco
The authors of the study report no relevant financial disclosures. Ilgen reports receiving grants from the Department of Veterans Affairs Health Services Research and Development Service, Military Operational Medicine Research Program and National Institutes of Health.