Depression, Chronic Pain, and Suicide by Overdose: On the Edge

Abstract

Comorbid conditions that pose risks for suicide, especially depression, are prevalent in people living with chronic pain. The true numbers of failed attempts and successful suicides are unknown and may never be determined. Yet risk factors for suicidal ideation are so high in this population that it must be assumed that some proportion of those who die of drug overdoses might have intended to end their lives, not just temporarily relieve their pain. The purpose of this manuscript is to highlight to clinicians the important association between chronic pain and intentional self-harm. Contemporary understanding of the epidemiology of depression and suicide and the relationship to chronic pain will be reviewed. Recommendations for the use of validated and practical screening tools as part of a comprehensive clinical assessment and for approaches to suicide prevention and interventions as crucial components of chronic pain management are outlined.

Mental Defeat Is Associated With Suicide Intent in Patients With Chronic Pain

“…The premise of the current study was a heightened risk of suicidality among patients with chronic pain [2,4,14]. Consistent with this, we found an elevated rate of suicide attempt in the current sample.…”

“…The distinction between a suicide attempt and a self-harming incident rests in the strength of one's intention/wish to end their life. It is not easy to distinguish whether a death by drug overdose was intentional or unintentional [2]. Clearly, not all selfharming incidents or suicide attempts end in fatality; the estimated rate of completed suicide in chronic pain is 23.3 per 100,000, which is again double compared to that recorded in the general population [3].…”

“…I can't take this anymore" [1] Chronic pain can be lethal; its unwelcome presence and debilitating impact can considerably increase the risk of suicidality among people living with chronic pain [2][3][4]. Several large-scale epidemiological surveys have now established that the presence of any pain condition doubles the risk of suicidal ideation (passive thoughts or active intent of committing suicide) and trebles that of suicide attempt in the general population [5][6][7].…”

A Descriptive Longitudinal Study of Chronic Pain Outcomes and Gender Differences in a Multidisciplinary Pain Management Centre

“…The strength of relationship between chronic pain and mood disorder remains unclear. The role of drug and alcohol dependence with or without mood disorders cannot be underestimated [31] [32]. Importantly, as shown in this study, modest pain relief alone would not be sufficient to create a positive impact in the life of a patient with chronic pain but it nevertheless is an important step forward before patient motivated into more adaptive behaviours of accepting and self-managing their chronic pain condition.…”

Perspective Crisis in Pain Management

“…"The true numbers of failed attempts and successful suicides are unknown and may never be determined. Yet, risk factors for suicidal ideation are so high in this population that it must be assumed that some proportion of those who die of drug overdoses might have intended to end their lives, not just temporarily relieve their pain [4]. "…”