Chronic Pain Seen as Risk Factor in Some Suicides.
Just under 10% of death certificates listed chronic pain diagnosis prior to death.
Chronic pain was present in just under 10% of recent suicide deaths in a large retrospective analysis using death certificates and related records as a data source on contributing factors.
Among more than 120,000 suicide deaths from 2003 to 2014, 8.8% of decedents age 10 and older had evidence of chronic pain, according to Emiko Petrosky, MD, MPH, of the CDC in Atlanta, and colleagues.
When broken down by year, the percentage of suicide decedents with chronic pain rose from 7.4% in 2003 to 10.2% in 2014, the researchers wrote in Annals of Internal Medicine.
Although death by firearm was the most common method of suicide among those with or without chronic pain (53.6% versus 51.4%, respectively), the percentage of those with chronic pain were far more likely to overdose on opioids (prescription and illicit) compared with individuals without chronic pain (16.2% versus 3.9%).
However, the prevalence of suicides due to opioid overdoses remained steady from 2003 to 2014, despite the increase in opioid prescribing in recent years.
“This finding suggests that increases in opioid availability are not associated with greater suicide risk from opioid overdose among patients with chronic pain,” Petrosky’s group stated, adding that future research should focus on exploring “factors other than opioid availability” underlying the causes of suicide among those living with chronic pain.
OPIOIDS MAY INCREASE THE RISK FOR SUICIDE
In an accompanying editorial, Mark Ilgen, PhD, of the University of Michigan at Ann Arbor, said that this relationship between chronic pain, opioid use, and suicide is rather complex, raising the point that access to a “lethal means” — a high quantity of opioids — may increase the risk for suicide, yet on the other hand, such treatment to alleviate suffering from chronic pain may also reduce the risk for suicide.
“The literature on the efficacy of opioids for chronic pain indicates that these medications often are imperfect in treating pain over the long run, and the association between higher opioid dosages and a greater risk for suicide may reflect the fact that those with a higher opioid dosage are more likely to have poorly controlled pain,” argued Ilgen, who suggested that a renewed focus be geared toward pain treatments and interventions “not only for the direct effect on pain and functioning but also as a method to raise hope in persons with chronic pain.”
Such pain treatment should also always be supplemented with mental health treatment for patients with pain and comorbid depression or anxiety, he recommended.
The researchers collected data from the National Violent Death Reporting System with linked death certificates, in which 18 states participated. Overall, there were 123,181 individuals who committed suicide, including 10,789 who suffered from chronic pain. Coroner, medical examiner, and law enforcement narratives were used to obtain information on chronic pain, which the researchers scanned for a references of nine different types of pain, as well as 120 medical conditions.
Among these individuals, the most common source of chronic pain was spine pain, which made up nearly a quarter of suicide decedents with chronic pain. This category of pain included back pain, degenerative disc disease, and spinal stenosis. The second most common type of chronic pain among suicide decedents was musculoskeletal pain (20.8%), which included arthritis, fibromyalgia, and lower limb pain. This was followed by disease-related pain reported by nearly 16% of decedents, which included pain from cancer, chronic obstructive pulmonary disease, and lupus.
Depression was also more prevalent among suicide decedents with chronic pain compared with those without pain (81.9% versus 74.6%). “Depression is a risk factor for chronic pain, and chronic pain, in turn, is a risk factor for depression,” the authors stated. They noted that a study limitation was an inability to assess this relationship more closely.
However, they warned healthcare providers to be vigilant and to screen for depression and suicidal behaviors among their patients with chronic pain, particularly among older patients.
Although the researchers noted that they did not stratify each medical condition by the risk of suicide, they suggested that future research should look at the specific pain conditions that are most closely associated with suicide.