Pain and suicide: what should we tell our trainees?

Abstract

Objective: This paper will emphasize the necessity to improve education about pain, its close relationship with suicide, and effective suicide screening as well as management strategies for medical providers. Methods: A review of the relevant literature. Results: Chronic pain is a debilitating medical condition affecting a significant percentage of the population worldwide. Considerable evidence suggests that pain is an independent risk factor for suicide and inadequately managing pain has been identified as a risk for suicidal behavior. Additionally, medications used to treat pain may also contribute to suicidal behavior. Extensive research on pain highlights deficiencies in the clinical management of pain with more gaps in care when patients have pain in combination with mental illness and suicidal behavior. Conclusion: Providing trainees with additional knowledge and equipping them with relevant tools to screen and manage chronic pain efficiently is a potential strategy to mitigate suicide risk. Also, trainees need to be educated on how to screen for suicidality in individuals with pain and apply suicide prevention interventions. With additional research, it is the hope that novel treatment modalities will be developed to treat pain to improve the quality of life of individuals suffering from this condition and to decrease suicide risk in this patient population.

Health-related quality of life of Korean older adults according to age, sex, and living arrangements: a cross-sectional study

“…In terms of old age, the reviews of recent literature pointed out that living alone, pain (chronic, psychological, and physical), and depression are associated with a higher risk of suicidal ideation and/or behavior ( 38 – 41 ). Older adults living alone with problems in one or more EQ-5D dimensions possess multiple risk factors associated with suicide, and they are likely underrepresented in KCHS-21.…”

Examining assisted suicide and euthanasia through the lens of healthcare quality

“…This does not consider the vulnerabilities of people with co-morbid terminal illnesses and mental illness. Depression is common in people experiencing pain, and as such pain may be regarded as a risk factor for suicidal thoughts and actions [68].…”

Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management

“…Engaging a patient in therapeutic risk management involves attending to the factors that matter to them, to increase their safety and reduce their current and future risk. In the short-term this risk management might include means restriction [68], treatment of insomnia [69], pain management [70], engaging social support, safeguarding interventions, and optimisation of psychiatric treatment. In the longterm it might include psychological therapy [71], therapeutic risk taking [72] and providing support with social integration.…”