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 The finding suggests chronic pain may be a risk factor for suicide,
the study authors say.
While the study can't prove that chronic pain contributed to
people's decisions to kill themselves, "we did see that mental
health issues, such as depression and anxiety were more common among
those with chronic pain," said lead author Dr. Emiko Petrosky, a
medical epidemiologist with the U.S. Centers for Disease Control and
Prevention (CDC) in Atlanta.
It's estimated that 25 million U.S. adults have some level of daily
pain and 10.5 million of them have considerable pain every day,
Petrosky and colleagues note in Annals of Internal Medicine.
"Health care providers caring for patients with chronic pain should
be aware of the risk for suicide," Petrosky told Reuters Health.
"Chronic pain is a huge public health problem. It's essential that
we improve chronic pain management through integrated patient
centered management that includes mental health care in addition to
medications for these patients."
Data for the study had been collected from 18 states between 2003
and 2014 by the CDC's National Violent Death Reporting System. Out
of 123,181 suicide deaths in the study, the records for 10,789, or
about 9 percent, included notations by officials - such as coroners,
medical examiners and law enforcement officers - that indicated
evidence of chronic pain.
The proportion of suicides committed by people suffering from
chronic pain increased during the study, rising from 7.4 percent in
2003 to 10.2 percent in 2014. But Petrosky's team also underscored
the fact that the percentage of people battling chronic pain also
rose during the same time period.
Back pain, cancer pain and arthritis pain accounted for a large
proportion of the chronic pain conditions.
More than half of the people with chronic pain who killed themselves
died from firearm related injuries, while 16.2 percent died from
opioid overdose. Still, chronic pain sufferers were three times as
likely as others to have tested positive for opioids when they died.
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That's an important stat, said Dr. Paul Nestadt of the department of
psychiatry and behavioral health at the Johns Hopkins School of
Medicine in Baltimore. "Opioids are depressants and they increase
the risk of depression," said Nestadt, who is not affiliated with
the new research. "Depression is one of the highest risk factors for
completing suicide."
The new study can't say anything about the state of chronic pain
management in this country, said Dr. Michael L. Barnett, a health
policy and management researcher at the Harvard T.H. Chan School of
Public Health and a primary care physician at Brigham & Women's
Hospital in Boston
But we do know "there aren't any medications that seem to be
particularly effective for chronic pain," said Barnett, who is not
affiliated with the new study. "Both opioids and NSAIDs are pretty
effective in treating acute pain, but not chronic pain. While people
often want a pill that will fix things, comprehensive pain
management is proven to be pretty effective."
A problem with this kind of study is you don't know what other risk
factors people had, said Dr. Ajay D. Wasan, vice president for
scientific affairs at the American Academy of Pain Medicine and a
professor of anesthesia and psychiatry at the University of
Pittsburgh Medical Center.
"Chronic pain is certainly an important risk factor, but we don't
know how important it is compared to other risk factors," said Wasan,
who was not affiliated with the new research. "Also, since chronic
pain is not really coded well at the time of a suicide, this is
probably an underestimate of the proportion of people who had
chronic pain. We do know that chronic pain can be a deadly disease."
SOURCE: http://bit.ly/2wYH0qu Annals of Internal Medicine, online
September 10, 2018.
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