Some Types of Pain Linked with Suicide Risk

People with pain caused by migraines, back issues or psychological distress may have an increased risk of suicide, a new study suggests. Researchers looked at records for more than 4.8 million people in the Veterans Affairs medical system. They focused on people with chronic (long-lasting) pain that was not related to cancer. In the next 3 years, more than 2,800 people with a pain-causing condition committed suicide. People with most pain conditions had higher rates of suicide than people without pain. Some people with pain also had mental-health conditions. Researchers adjusted the numbers to account for the effects this might have on suicide rates. Three causes of pain were still linked with a higher suicide risk. The increased risk was 13% with back pain and 34% with migraines. The highest increased risk was 58% for people with psychogenic pain. This is a rare and poorly understood type of pain, a study author told HealthDay News. It is thought to be caused by psychological distress. The journal JAMA Psychiatry published the study. HealthDay wrote about it May 22.

By Robert H. Shmerling, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

When I first learned that people with chronic pain might have an increased risk of suicide, I assumed it was because the unrelenting pain might lead to depression and despair.

But a new study challenges this assumption. The study explored the link between non-cancer pain and suicide among nearly 5 million people receiving care in the Veterans Affairs health care system. Researchers published results in the latest edition of the journal JAMA Psychiatry.

Here's what they found:

• Painful conditions were remarkably common. Among the group studied, 43% had arthritis and 23% had back pain.
• The risk of suicide was higher among those with back pain (13% increase), migraine (34% increase) and psychogenic pain (58% increase) than among those who did not have these conditions. (Psychogenic pain is thought to be caused by psychological distress.)
• Depression did not account for the link between these painful conditions and suicide risk.
• The risk of suicide was not significantly increased among all painful conditions studied. Those with arthritis, fibromyalgia, nerve disease (neuropathy) or tension headache did not have an increased risk of suicide.

This study raises several questions in my mind. For example:

• Why are some painful conditions linked with an increased suicide risk while others are not?
• Would more effective pain control lower suicide risk?
• Does it matter whether pain is mild or severe?
• Does the type of arthritis matter? There are more than 100 types. This study did not look at different types separately.
• Would results have been different if the study had included younger adults, more women or people with cancer? Most of those in the study were older men because it included only people getting their care from the VA. And the study excluded people with cancer.

Even before we answer these questions, I think the main message of this study is that people with certain painful conditions may have an increased risk of suicide. This seems to be especially true for those with back pain, migraines and psychogenic pain. For doctors, patients and their loved ones, awareness of this connection could lead to some important changes.

What Changes Can I Make Now?

If you have significant pain on a regular basis, talk to your doctor. Discuss the cause of your pain and how it can be better controlled.

Keep an open mind about treatment. Some conditions are not well-treated with the medicines we have now. Consider fibromyalgia. Even when taking the best-researched, government-approved medicines for this condition, many people continue to have pain. But a recent study found that tai chi could help this condition.

Consider options other than medicine for your pain, especially if medicines have not worked well or caused troublesome side effects.

Let your doctor know if you have thoughts of self-harm or symptoms of depression. These include:

• Profound and prolonged feelings of guilt, sadness or worthlessness
• Lack of energy or motivation
• Lack of interest or pleasure in activities that you once enjoyed
• Changes in weight, appetite or sleep
• Trouble concentrating or making decisions

Changes in your health habits may have a positive impact on mood. These include:

• Improving your diet
• Drinking less alcohol
• Getting more exercise
• Cutting back on caffeine, especially if it impairs your sleep

If you've been diagnosed with depression, know your treatment options. They include counseling, antidepressant medicines or both. Electroconvulsive therapy (also called electroshock therapy) is usually reserved for people with severe depression that does not improve with other treatments.

Recognizing depression and getting help can make a big difference in how you feel and function.

What Can I Expect Looking to the Future?

The reasons that people elect to end their own lives are often unknown or hard to understand. I hope that in the future we will have a better understanding of why some people choose suicide. More importantly, we need better preventive measures. And that could include improvements in how we treat pain.