Suicidality in chronic pain: A review of the prevalence, risk factors and psychosocial links

Department of Psychiatry, University of Oxford, Oxford, England, United Kingdom
Psychological Medicine (Impact Factor: 5.94). 06/2006; 36(5):575-86. DOI: 10.1017/S0033291705006859
Source: PubMed


This paper reviews and integrates the growing literature concerning the prevalence of and risk factors for suicidality in chronic pain.
A series of systematic searches in MEDLINE and PsychINFO identified 12 relevant articles examining suicide, suicide attempts, and suicidal ideation in chronic pain. A selection of theoretical and empirical work identifying psychological processes that have been implicated in both the pain and suicide literature and which may be related to increased suicidality was also reviewed.
Relative to controls, risk of death by suicide appeared to be at least doubled in chronic pain patients. The lifetime prevalence of suicide attempts was between 5% and 14% in individuals with chronic pain, with the prevalence of suicidal ideation being approximately 20%. Eight risk factors for suicidality in chronic pain were identified, including the type, intensity and duration of pain and sleep-onset insomnia co-occurring with pain, which appeared to be pain-specific. Helplessness and hopelessness about pain, the desire for escape from pain, pain catastrophizing and avoidance, and problem-solving deficits were highlighted as psychological processes relevant to the understanding of suicidality in chronic pain.
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.

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    • "Depression is a well-established risk factor for suicide, but there is also evidence that patients with chronic pain are at increased risk for suicidal ideation (Ilgen et al., 2008) and for suicide M a n u s c r i p t 36 (Tang and Crane, 2006). Moreover, former NFL players with depression and chronic pain are much more likely to report life stress and financial difficulty than former players without depression (Schwenk et al., 2007). "
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    ABSTRACT: Chronic traumatic encephalopathy (CTE) has been described in the literature as a neurodegenerative disease with: (i) localized neuronal and glial accumulations of phosphorylated tau (p-tau) involving perivascular areas of the cerebral cortex, sulcal depths, and with a preference for neurons within superficial cortical laminae; (ii) multifocal axonal varicosities and axonal loss involving deep cortex and subcortical white matter; (iii) relative absence of beta-amyloid deposits; (iv) TDP-43 immunoreactive inclusions and neurites; and (v) broad and diverse clinical features. Some of the pathological findings reported in the literature may be encountered with age and other neurodegenerative diseases. However, the focality of the p-tau cortical findings in particular, and the regional distribution, are believed to be unique to CTE. The described clinical features in recent cases are very similar to how depression manifests in middle-aged men and with frontotemporal dementia as the disease progresses. It has not been established that the described tau pathology, especially in small amounts, can cause complex changes in behavior such as depression, substance abuse, suicidality, personality changes, or cognitive impairment. Future studies will help determine the extent to which the neuropathology is causally related to the diverse clinical features. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Jul 2015 · Neuroscience & Biobehavioral Reviews
    • "Emerging research suggests that people suffering from chronic pain have almost double the risk of death by suicide (Tang and Crane, 2006). Amongst people with chronic pain, rates of lifetime ideation range from 21% to 50%, current ideation from 0% to 24%, and rates of lifetime suicidal attempts from 5% to 14% (Tang and Crane, 2006). These studies, however, have generally been based on small, clinical samples, so it is unknown if the same pattern exists in the general pain population. "
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    ABSTRACT: Research suggests that people suffering from chronic pain have elevated rates of suicidality. With an ageing population, more research is essential to gain a better understanding of this association. To document the prevalence and correlates of chronic pain and suicide, and estimate the contribution of chronic pain to suicidality. Data from the 2007 Australian National Survey of Mental Health and Wellbeing, a nationally representative household survey on 8841 people, aged 16-85 years, was analysed. The odds of lifetime and past 12-month suicidality were two to three times greater in people with chronic pain. Sixty-five percent of people who attempted suicide in the past 12 months had a history of chronic pain. Chronic pain was independently associated with lifetime suicidality after controlling for demographic, mental health and substance use disorders. Health care professionals need to be aware of the risk of suicidality in patients with chronic pain, even in the absence of mental health problems. © The Royal Australian and New Zealand College of Psychiatrists 2015.
    No preview · Article · Feb 2015 · Australian and New Zealand Journal of Psychiatry
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    • "Prior research has identified a link between pain and suicide. In a recent review, it was reported that chronic pain was associated with increased risk of suicide mortality and that the rates of suicidal ideation were higher in individuals with pain than those without [10] [11]. Edwards and colleagues found that over 30% of patients seeking treatment for chronic pain reported some form of recent suicidal ideation [12]. "
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    ABSTRACT: Introduction. Chronic pain of the oral cavity is a long-term condition and like all other types of chronic pain is associated with numerous comorbidities such as depression or anxiety. Case Presentation. This is a case of a 93-year-old patient suffering from chronic oral cavity pain who repeatedly stabbed his palate due to ongoing local pain, over the last few months, which he could not further tolerate. The patient was suffering from depression and also a diagnosis of "burning mouth syndrome" (BMS) was made. Discussion. Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue or other oral sites. BMS has high psychiatric comorbidity but can occur in the absence of psychiatric diagnosis. Patients with multiple forms of pain must be considered as potential candidates for underdiagnosed depression (major) and suicidal thoughts.
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