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Welcome to Impact Factor, your weekly commentary on the most interesting or important medical studies in the literature. I am Perry Wilson.
This Week: Is Chronic Pain a Risk Factor for Suicide, as We Look at This Study Published in Annals of Internal Medicine[1]:
Chronic pain is prevalent in the United States, with most studies suggesting a prevalence of about 10% in adults. For health care providers, chronic pain is frustrating. We have limited effective therapies and patients have limited ability to access these therapies.
For many of us, the chronic back pain that our patient complains about is at the bottom of the list of problems, to be treated when, and if, we can solve the "most important problems". the Annals The paper suggests that we need to take chronic pain more seriously, even going so far as to explicitly state that "chronic pain could be a significant risk factor for suicide."
The study identified 123,000 people who committed suicide from the National System for Reporting Violent Deaths, which had data from 18 states. The researchers then analyzed each record to determine if the person was suffering from chronic pain. 8.8% did it.
Let's stop for a moment. Although the data shows us that some people who die of suicide suffer from chronic pain, this percentage seems quite similar to the overall percentage of Americans suffering from chronic pain.
Is chronic pain a risk factor or is it simply the background noise of modern society?
I asked the senior author of the study, Emiko Petrosky, a medical epidemiologist of the Centers for Disease Control and Prevention. She pointed out that in US surveys, researchers can simply ask if a person is suffering from chronic pain. "But for us, we can not ask the person directly.It is very possible that people suffer from chronic pain, but their loved ones did not realize how much it affected them or a factor in suicide."
In other words, 8.8% can be a serious underestimate. Which leads to interesting questions. I focused a lot on opioids.
Whenever I speak of the opioid epidemic and the cautiousness with which doctors must prescribe opioids for chronic pain, I feel an important reaction from chronic pain patients and their providers, who believe that opioids are the only thing keeping Suicide patients.
This analysis is in fact supported by the researcher's analysis of 95 suicide notes from individuals with chronic pain; 64 of these notes indicated that pain played a role in their decision to die by suicide – frightening and heartbreaking data.
On the other hand, access opioids provides a method of suicide. Indeed, 16.2% of people with chronic pain died from an overdose of opioids, compared with only 3.9% of those without chronic pain.
Does chronic pain cause suicide? The study can not tell us for sure, but there is some clue that this could play such a role. For example, people who committed suicide with chronic pain were less likely to have other suicide triggers, such as a problem with an intimate partner, a recent argument or a stressor. In other words, chronic pain can reduce the suicide threshold.
Petrosky says one of the conclusions is clear: "Improving the management of chronic pain is essential through integrated patient-centered pain management, including behavioral and mental care, in addition to drugs for these patients.
If you need help for yourself or for someone else, please contact the National Suicide Prevention Lifeline. Speak at 1-800-273-TALK (8255)
Chat: www.suicidepreventionlifeline.org
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