Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links

Abstract

Programmatic research is urgently required to investigate the role of both general and pain-specific risk factors for suicidality, to examine how the psychological processes mentioned above mediate or exacerbate suicidality, and to develop enhanced interventions for pain patients at risk.

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

“…52 Second, in comparison to those without chronic pain, individuals with chronic pain have twice the risk for suicide. 53 Among depressed inpatients 54 and outpatients, 51 chronic pain increases the risk of suicidal ideation. Third, comorbid chronic pain and depression is associated with more disability than either condition alone.…”

The Canadian STOP-PAIN project – Part 1: Who are the patients on the waitlists of multidisciplinary pain treatment facilities?

“…For example, an international WHO survey of nearly 26,000 patients attending primary care facilities showed that chronic pain sufferers exhibited a four-fold increase in the odds of having an anxiety or depressive disorder relative to patients without persistent pain. 26 Another recent review 31 revealed that the risk of death by suicide was at least doubled in individuals suffering from chronic pain. In the present study, suicidal ideation was present in more than one-third of subjects, underscoring the need for clinicians to thoroughly assess depression.…”

Recovery From Depressive Symptoms Over the Course of Physical Therapy: A Prospective Cohort Study of Individuals With Work-Related Orthopaedic Injuries and Symptoms of Depression

“…Previous research suggests that the prevalence of suicidal thoughts and suicide attempts is 2 times higher among individuals suffering from pain conditions compared to the general public. 60 Previous research also suggests that individuals with both suicidal thoughts and a plan of how they intend to act on these thoughts (eg, method, time, place, and means) are at an elevated risk of committing suicide. 19 In response to these findings, clinical practice guidelines for primary care clinicians recommend that all patients with depressive symptoms be evaluated for their risk of committing suicide.…”

“…One option for clinicians is to simply proceed with treatment as usual. However, due to the risk of developing adverse complications associated with depressive symptoms, which in the most extreme cases may include suicide, 60 this course of action may be detrimental for many patients. Another option for physical therapists is to refer all patients presenting with symptoms of depression to mental health services.…”