Skip to main content
SpringerLink
Log in

Suicide in Chronic Pain Patients: Risk Factors and Clinical Considerations

  • Chapter
  • First Online:
Suicide Prevention

Abstract

Chronic pain patients are at increased risk of suicide. Patients with chronic pain are at increased suicide risk due to neurobiological vulnerabilities, demographic risk factors, psychiatric comorbidities, personality traits, and the misuse of opioid medications. Risk for suicide is much more likely when vulnerable individuals enter time periods of great stress, loss, or transition. Chronic pain patients are also more likely to enter into vulnerable periods (such as pain exacerbations, advanced age, or loss), which may induce a suicidal crisis. Warning signs of an imminent suicidal crisis include increased isolation, feelings of hopelessness, and decreases in problem-solving abilities or cognitive control. An actuarial approach to suicide risk in chronic pain patients is crucial to ensure safe and effective management. Psychotherapeutic interventions can aid suicidal pain patients in successfully managing suicidal crises through building distress tolerance skills, challenging catastrophic thoughts, and instilling hope in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. Lancet. 2011;377(9784):2226–35.

    Article  CAS  PubMed  Google Scholar 

  2. Smith MT, Edwards RR, Robinson RC, Dworkin RH. Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk. Pain. 2004;111(1):201–8. https://doi.org/10.1016/j.pain.2004.06.016.

    Article  PubMed  Google Scholar 

  3. Tang NK, Crane C. Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links. Psychol Med. 2006;36(05):575–86.

    Article  PubMed  Google Scholar 

  4. Swett JE, McMahon SB, Wall PD. Long ascending projections to the midbrain from cells of lamina I and nucleus of the dorsolateral funiculus of the rat spinal cord. J Comp Neurol. 1985;238(4):401–16.

    Article  CAS  PubMed  Google Scholar 

  5. Millan MJ. Descending control of pain. Prog Neurobiol. 2002;66:335–474.

    Article  Google Scholar 

  6. Hoffman MD, Shepanski MA, MacKenzie SP, Clifford PS. Experimentally induced pain perception is acutely reduced by aerobic exercise in people with chronic low back pain. J Rehabil Res Dev. 2005;42(2):183.

    Article  PubMed  Google Scholar 

  7. Staud R. Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions. Expert Rev Neurother. 2012;12(5):577–85.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Duncan GH, Bushnell MC, Bates RE, Dubner RO. Task-related responses of monkey medullary dorsal horn neurons. J Neurophysiol. 1987;57(1):289–310.

    Article  CAS  PubMed  Google Scholar 

  9. Zubieta JK, Heitzeg MM, Smith YR, Bueller JA, Xu K, Xu Y, et al. COMT val158met genotype affects μ-opioid neurotransmitter responses to a pain stressor. Science. 2003;299(5610):1240–3.

    Article  CAS  PubMed  Google Scholar 

  10. Uhl GR, Sora I, Wang Z. The μ opiate receptor as a candidate gene for pain: polymorphisms, variations in expression, nociception, and opiate responses. PNAS. 1999;96(14):7752–5.

    Article  CAS  PubMed  Google Scholar 

  11. Devor M, Raber P. Heritability of symptoms in an experimental model of neuropathic pain. Pain. 1990;42(1):51–67.

    Article  CAS  PubMed  Google Scholar 

  12. Coghill RC, McHaffie JG, Yen YF. Neural correlates of interindividual differences in the subjective experience of pain. PNAS. 2003;100(14):8538–42.

    Article  CAS  PubMed  Google Scholar 

  13. Elman I, Borsook D, Volkow ND. Pain and suicidality: insights from reward and addiction neuroscience. Prog Neurobiol. 2013;109:1–27. https://doi.org/10.1016/j.pneurobio.2013.06.003.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Meerwijk EL, Ford JM, Weiss SJ. Suicidal crises because of diminishing tolerance to psychological pain. Brain Imaging Behav. 2013;7(3):245–7. https://doi.org/10.1007/s11682-013-9234-3.

    Article  PubMed  Google Scholar 

  15. Nock MK, Kessler RC. Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. J Abnorm Psychol. 2006;115(3):616.

    Article  PubMed  Google Scholar 

  16. Nock MK, Hwang I, Sampson NA, Kessler RC. Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(8):868–76.

    Article  CAS  PubMed  Google Scholar 

  17. Scott KM, Hwang I, Chiu WT, Kessler RC, Sampson NA, Angermeyer M, et al. Chronic physical conditions and their association with first onset of suicidal behavior in the world mental health surveys. Psychosom Med. 2010;72(7):712–9.

    Article  PubMed  Google Scholar 

  18. Ohayon MM, Schatzberg AF. Chronic pain and major depressive disorder in the general population. J Psychiatr Res. 2010;44(7):454–61.

    Article  PubMed  Google Scholar 

  19. Gerrits MM, van Oppen P, van Marwijk HW, Penninx BW, van der Horst HE. Pain and the onset of depressive and anxiety disorders. Pain. 2014;155(1):53–9.

    Article  PubMed  Google Scholar 

  20. Larson SL, Clark MR, Eaton WW. Depressive disorder as a long-term antecedent risk factor for incident back pain: a 13-year follow-up study from the Baltimore Epidemiological Catchment Area sample. Psychol Med. 2004;34(02):211–9.

    Article  CAS  PubMed  Google Scholar 

  21. Rudy TE, Kerns RD, Turk DC. Chronic pain and depression: toward a cognitive-behavioral mediation model. Pain. 1988;35(2):129–40.

    Article  CAS  PubMed  Google Scholar 

  22. RK MH, Weiss RD, Cornelius M, Martel MO, Jamison RN, Edwards RR. Distress intolerance and prescription opioid misuse among patients with chronic pain. J Pain. 2016;17(7):806–14.

    Article  Google Scholar 

  23. Garland EL, Brown SM, Howard MO. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med. 2016;39(1):128–38.

    Article  PubMed  Google Scholar 

  24. Racine M, Choinière M, Nielson WR. Predictors of suicidal ideation in chronic pain patients: an exploratory study. Clin J Pain. 2014;30(5):371–8.

    PubMed  Google Scholar 

  25. Ilgen MA, Kleinberg F, Ignacio RV, Bohnert AS, Valenstein M, McCarthy JF, et al. Noncancer pain conditions and risk of suicide. JAMA Psychiat. 2013;70(7):692–7.

    Article  Google Scholar 

  26. Marino EN, Rosen KD, Gutierrez A, Eckmann M, Ramamurthy S, Potter JS. Impulsivity but not sensation seeking is associated with opioid analgesic misuse risk in patients with chronic pain. Addict Behav. 2013;38(5):2154–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Cheatle MD. Depression, chronic pain, and suicide by overdose: on the edge. Pain Med. 2011;12(s2):S43–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Greenwood KA, Thurston R, Rumble M, Waters SJ, Keefe FJ. Anger and persistent pain: current status and future directions. Pain. 2003;103(1–2):1–5.

    Article  PubMed  Google Scholar 

  29. Bruns D, Disorbio JM, Hanks R. Chronic nonmalignant pain and violent behavior. Curr Pain Headache Rep. 2003;7(2):127–32.

    Article  PubMed  Google Scholar 

  30. Fishbain DA, Bruns D, Lewis JE, Disorbio JM, Gao J, Meyer LJ. Predictors of homicide–suicide affirmation in acute and chronic pain patients. Pain Med. 2011;12(1):127–37.

    Article  PubMed  Google Scholar 

  31. Margari F, Lorusso M, Matera E, Pastore A, Zagaria G, Bruno F, et al. Aggression, impulsivity, and suicide risk in benign chronic pain patients–a cross-sectional study. Neuropsychiatr Dis Treat. 2014;10:1613.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cavanagh JTO, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(3):395–405.

    Article  CAS  PubMed  Google Scholar 

  33. Wolfe F, Häuser W, Hassett AL, Katz RS, Walitt BT. The development of fibromyalgia–I: examination of rates and predictors in patients with rheumatoid arthritis (RA). Pain. 2011;152(2):291–9.

    Article  PubMed  Google Scholar 

  34. Wilson KG, Kowal J, Henderson PR, McWilliams LA, Péloquin K. Chronic pain and the interpersonal theory of suicide. Rehabil Psychol. 2013;58(1):111.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ilgen MA, Bohnert AS, Ignacio RV, McCarthy JF, Valenstein MM, Kim HM, et al. Psychiatric diagnoses and risk of suicide in veterans. Arch Gen Psychiatry. 2010;67(11):1152–8.

    Article  PubMed  Google Scholar 

  36. Overholser JC, Braden A, Dieter L. Understanding suicide risk: identification of high-risk groups during high-risk times. J Clin Psychol. 2012;68(3):349–61.

    Article  PubMed  Google Scholar 

  37. Foster T. Adverse life events proximal to adult suicide: a synthesis of findings from psychological autopsy studies. Arch Suicide Res. 2011;15(1):1–5.

    Article  PubMed  Google Scholar 

  38. Walker J, Sofaer B, Holloway I. The experience of chronic back pain: accounts of loss in those seeking help from pain clinics. Eur J Pain. 2006;10(3):199.

    Article  PubMed  Google Scholar 

  39. Liu RT, Kleiman EM, Nestor BA, Cheek SM. The hopelessness theory of depression: a quarter-century in review. Clin Psychol. 2015;22(4):345–65.

    Google Scholar 

  40. Abela JR, Seligman ME. The hopelessness theory of depression: a test of the diathesis-stress component in the interpersonal and achievement domains. Cognit Ther Res. 2000;24(4):361–78.

    Article  Google Scholar 

  41. Beck U. Risk society: towards a new modernity. London: Sage; 1992.

    Google Scholar 

  42. Overholser JC, Fisher L, Braden A, Peak N. Despair beyond repair? Severity of hopelessness in depressed psychiatric inpatients. J Dep Ther. 2015;1(1):1–10.

    Article  Google Scholar 

  43. Wenzel A, Beck AT. A cognitive model of suicidal behavior: theory and treatment. Appl Prev Psychol. 2008;12(4):189–201.

    Article  Google Scholar 

  44. Marty M, Rozenberg S, Duplan B, Thomas P, Duquesnoy B, Allaert F. Quality of sleep in patients with chronic low back pain: a case-control study. Eur Spine J. 2008;17(6):839–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Ancoli-Israel S. The impact and prevalence of chronic insomnia and other sleep disturbances associated with chronic illness. Am J Manag Care. 2006;12(8 Suppl):S221–9.

    PubMed  Google Scholar 

  46. Bahouq H, Allali F, Rkain H, Hmamouchi I, Hajjaj-Hassouni N. Prevalence and severity of insomnia in chronic low back pain patients. Rheumatol Int. 2013;33(5):1277–81.

    Article  CAS  PubMed  Google Scholar 

  47. Schrimpf M, Liegl G, Boeckle M, Leitner A, Geisler P, Pieh C. The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis. Sleep Med. 2015;16(11):1313–20.

    Article  PubMed  Google Scholar 

  48. Winsper C, Tang NK. Linkages between insomnia and suicidality: prospective associations, high-risk subgroups and possible psychological mechanisms. Int Rev Psychiatry. 2014;26(2):189–204.

    Article  PubMed  Google Scholar 

  49. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624–45.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Case Western Reserve University, Cleveland, OH, USA

    Jennifer K. Lehmann M.A.

  2. Chronic Pain Rehabilitation Section, Center for Neurological Restoration, Cleveland Clinic Lerner College of Medicine, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Xavier F. Jimenez M.D., M.A.

Authors
  1. Jennifer K. Lehmann M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xavier F. Jimenez M.D., M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xavier F. Jimenez M.D., M.A. .

Editor information

Editors and Affiliations

  1. Epilepsy Center/ Psychiatry Department, Neurological Institute - Cleveland Clinic, Cleveland, Ohio, USA

    Tatiana Falcone

  2. Begun Center for Violence Prevention Research and Education, Jack, Joseph, and Morton Mandel School of Applied Sciences School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA

    Jane Timmons-Mitchell

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lehmann, J.K., Jimenez, X.F. (2018). Suicide in Chronic Pain Patients: Risk Factors and Clinical Considerations. In: Falcone, T., Timmons-Mitchell, J. (eds) Suicide Prevention. Springer, Cham. https://doi.org/10.1007/978-3-319-74391-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74391-2_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74390-5

  • Online ISBN: 978-3-319-74391-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation