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

Tang, Nicole K. Y.; Beckwith, Philippa; Ashworth, Polly

doi:10.1097/ajp.0000000000000276

Cited by 31 publications

(26 citation statements)

References 48 publications

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“…This could explain the association between depression and pain intensity and interference found in univariable analyses in our study (this was not confirmed in multivariable analysis, probably due to collinearity with suicide risk). Second, pain catastrophizing (exaggerated, negative focus on pain) can contribute to depression, pain intensity, disability [43] and mental defeat [44]. In fact, magnitude of depression and pain catastrophizing can predict the occurrence and degree of suicidal ideation [45].…”

Section: Discussionmentioning

confidence: 99%

Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial)

et al. 2017

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BackgroundPain in opioid-dependent patients is common but data measuring the course of pain (and its correlates) using validated scales in patients initiating methadone treatment are sparse. We aimed to assess pain and its interference in daily life, associated correlates, and undertreatment before and during methadone treatment.MethodsThis is a secondary analysis using longitudinal data of a randomized trial comparing two methadone initiation models. We assessed the effect of methadone initiation and other correlates on pain intensity and interference (using the Brief Pain Inventory) at months 0, 6 and 12 using a mixed multinomial logistic regression model.ResultsThe study group comprised 168 patients who had data for either pain intensity or interference for at least one visit. Moderate to severe pain was reported in 12.9% of patients at M0, 5.4% at M6 and 7.3% at M12. Substantial interference with daily functioning was reported in 36.0% at M0, 14.5% at M6 and 17.1% at M12. Of the 98 visits where patients reported moderate to severe pain or substantial interference, 55.1% reported no treatment for pain relief, non-opioid analgesics were reported by 34.7%, opioid analgesics by 3.1% and both opioid and non-opioid analgesics by 7.1%. Methadone was associated with decreased pain intensity at 6 months (OR = 0.29, p = 0.04) and 12 months (OR = 0.30, p = 0.05) of follow-up and tended to be associated with substantial pain interference. Suicide risk was associated with both pain intensity and pain interference.ConclusionsMethadone in opioid-dependent patients can reduce pain. However, undertreatment of pain in methadone patients remains a major clinical concern. Patients with pain are at higher risk of suicide. Adequate screening and management of pain in this population is a priority and needs to be integrated into routine comprehensive care.

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Section: Discussionmentioning

confidence: 99%

Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial)

et al. 2017

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“…Mental defeat is also a strong correlate of pain interference, depression and psychosocial disability in people with chronic pain, with 44% of the variance in depression explained by mental defeat 32 . Additionally Tang et al 3 , demonstrated that mental defeat was a stronger correlate of worst-ever suicidal intent among individuals with chronic pain, (compared to anxiety, depression and pain catastrophizing), and that the combination of mental defeat and pain intensity contributed more variance to worst-ever suicide ideation than pain intensity alone 3 .…”

Section: Defeat (And Mental Defeat)mentioning

confidence: 99%

“…Given that mental defeat is associated with suicidal intent in individuals with chronic pain 3 and that numerous studies have demonstrated an association between defeat and suicidal behaviour 29,30,34 , a logical next step is to investigate whether individuals with chronic pain also exhibit elevated levels of general defeat, and whether general defeat is associated with suicidal ideation and/or behaviour in this population. Assuming at least a degree of overlap between mental defeat and defeat, (half the items in the Pain Self Perception Scale -the 24-item questionnaire used to assess mental defeat -are drawn from the defeat measure, the 'D-Scale' 28 ) it would be expected that mental defeat would function in a similar way to the broader construct.…”

Section: Defeat (And Mental Defeat)mentioning

confidence: 99%

“…Individuals with chronic pain are a high-risk group for suicide 1 ; lifetime prevalence is estimated to be 23% for suicidal ideation and 15% for suicide attempts 2 , with other studies finding 5-23% of individuals with chronic pain have attempted suicide 3,4 . A large register-based study from Denmark found the incidence rate ratio of suicide attempt in those with chronic pain to be almost fourfold higher than individuals in the general population without chronic pain.…”

Section: Introductionmentioning

confidence: 99%

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Understanding suicidal ideation and behaviour in individuals with chronic pain: a review of the role of novel transdiagnostic psychological factors

Rodham

Crane

2020

The Lancet Psychiatry

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Individuals with chronic pain are at elevated risk of suicide, yet psychosocial factors that may be involved in increasing or decreasing vulnerability for suicidal ideation and behaviour have received little attention. Extant literature on the topic of suicide in individuals with chronic pain only incorporates a limited number of the wide array of known vulnerability and protective factors from the field of suicide research. The current review focuses on transdiagnostic psychological processes, i.e. processes of relevance for both chronic pain and suicide. We synthesize a selection of the previous literature on chronic pain and suicide, concentrating on previously unexplored and underexplored lines of research, including future orientation, mental imagery and psychological flexibility. A far greater degree of cross-pollination between the fields of chronic pain and suicide research is required if we are to progress in our understanding of why some people with chronic pain become suicidal and others do not.

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“…Patients with persistent severe pain are significantly more likely to attempt suicide than those without pain. In particular, pain intensity, mental defeat, functional limitations, and being perceived as a burden to others is strongly associated with suicidal ideation and attempts [12][13][14]. Even after controlling for life-limiting diseases, those with severe chronic pain die at a 50% higher rate (especially from cardiovascular events) over 10 years than those without pain [15].…”

Section: Introductionmentioning

confidence: 99%

The Conundrum of Treating Chronic Pain in Older Adults

Arnstein

2016

J Aging Sci

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Abstract:Despite remarkable advances in healthcare, chronic pain afflicting millions of older adults remains poorly treated. Intense or prolonged exposure to pain creates degenerative changes throughout the nervous system, which intensifies, prolongs and spreads it. The loss of brain gray matter with persistent pain greatly outpaces that seen with normal aging and can explain the learning, memory and emotional difficulties experienced. This loss can be partially reversed with effective treatment.

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

Cited by 31 publications

References 48 publications

Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial)

Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial)

Understanding suicidal ideation and behaviour in individuals with chronic pain: a review of the role of novel transdiagnostic psychological factors

The Conundrum of Treating Chronic Pain in Older Adults

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