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Chronic Pain, Opioids, and Suicide

Welcome to Impact Factor, your weekly commentary
on the most interesting or important medical studies in the literature today. I’m Perry Wilson. This week – is chronic pain a risk factor
for suicide as we examine this study appearing in the Annals of Internal Medicine. Chronic pain is widespread in the US with
most studies suggesting a prevalence of around 10% among adults. For health care providers, chronic pain is
frustrating. We have limited effective therapies and patients
have limited ability to access those therapies. For many of us, the chronic back pain our
patient complains of goes to the bottom of the problem list, to be dealt with when, and
if, we can get the “more important issues” cleared up. The Annals paper suggests that we need to
be taking chronic pain more seriously though, going so far as to state explicitly that “chronic
pain might be an important risk factor for suicide”. The study identified 123,000 individuals who
died by suicide from the National Violent Death Reporting System which had data from
18 states. They then analyzed each record to determine
if the individual had chronic pain. 8.8% did. Let’s stop there for a moment. While this data shows us that some people
who die from suicide have chronic pain, that percentage seems pretty similar to the overall
percent of Americans who have chronic pain. Is chronic pain a risk factor, or is it just
the background noise of modern society? I asked the study’s lead author Emiko Petrosky,
a Medical Epidemiologist with the Centers for Disease Control. She pointed out that in US survey studies,
researchers can simply ask if an individual has chronic pain, “But for us, we’re not able to ask the
person directly. It’s very possible that people had chronic
pain but either their loved ones didn’t realize how much it affected them or the loved
ones didn’t disclose that pain was a factor in the suicide.” In other words, 8.8% may be a serious underestimation. Which leads to some interesting questions. I found myself focusing quite a bit on opioids. Every time I talk about the opioid epidemic
and how physicians should be careful prescribing opioids for chronic pain, I get a significant
backlash from patients with chronic pain and their providers who feel that opioids are
the only thing keeping patients from suicide. This concern is actually supported by the
researcher’s analysis of 95 suicide notes from individuals with chronic pain. 64 of those notes stated pain played a role
in their decision to die by suicide. This is chilling and heartbreaking data. On the other hand, access to opioids provides
a suicide method. Indeed 16.2% of the individuals with chronic
pain died from opioid overdose, compared to just 3.9% of those without chronic pain. Does chronic pain cause suicide? The study can’t tell us for sure, but there
are some hints it may play such a role. For example, individuals who died from suicide
with chronic pain were less likely to have other suicide triggers like a problem with
an intimate partner, a recent argument, or a life stressor. In other words, chronic pain may reduce the
threshold for suicide. Taken together, Dr. Petrosky says one conclusion
is clear: “It is essential that we improve chronic
pain management through integrated patient-centered pain management that includes behavioral and
mental healthcare in addition to medication for these patients.” If you need help for yourself or someone else,
please contact the National Suicide Prevention Lifeline Talk: 1-800-273-TALK (8255). Chat: www.suicidepreventionlifeline.org

18 thoughts on “Chronic Pain, Opioids, and Suicide

  1. I have been a chronic pain patient and a Disabled nurse. Suffering is very horrible and led me to get a passport to go to Switzerland if the suffering became to much. I recently was fired by my doctor of 10 years related to the pressure the government has decided to put on doctors. I have already decided to die, when the detox starts next month, increase of pain, and the detox alone could kill me along with the stigma for"Comfort" from Excruciating Pain, sorry, this 59 year old female has suffered for 13 years. I am hoping the government from hell is happy with my demise, I am sure they will. Torture is worse than Death. Fuck Off to everyone who denies this will never happen to you along with the genocide of the In Valid. I really could care less about staying alive for more BS from a government, Country, and stupid people, all who believe" we need are government to keep us safe". I will not beg for anything related to the suffering of people in a fasist System.

  2. Everything I read says the percentage of chronic pain sufferers is more like 30% (100 million Americans) so better get that 10% revised upward slightly.

  3. The most recent stats from the CDC indicate that ILLEGAL illicit street opiate overdose deaths rose 45% in 2017 alone, while prescription overdoses were flat. Does this finally indicate that the problem lies not in the doctors office, but in the streets? Can we agree to address the global drug trade and cartels that are flooding the country with illegally produced toxic poisonous drugs?
    Yet suicide also increased nearly 4%. The number of prescriptions is at 2003 levels, and the outcry, and outrage, from the chronic pain community of patients is as loud as it can be, and it will get louder–pain is untreated and under-treated, because the government and the CDC chose to target the most vulnerable populations to fight the so-called 'war on opioids.' That is they chose to severely restrict the access to appropriate analgesics in this country. Taking people's pain meds away from them did not result in their diseases and injuries suddenly curing themselves. The rhetoric of the anti-pharma crowd outright ignores the disease and injury factors requiring pain relief.
    If there are some 9,000 disease conditions known to the human body, and we only have treatments for about 500 of them, then that statistically significant group of people with painful auto-immune diseases, congenital diseases, diseases like cancer (that once were a death sentence but now have a range of effective but certainly not side-effect free treatments), along with an aging demographic of baby boomers who have gotten older, are getting sick and are dying, along with a war that is now going on 17 years–we have a perfect storm.
    Untreated chronic pain results in litany of cascading health problems that cause the deterioration of the patient, cardiac arrest and stroke, diabetes, wasting, mental health problems. They suffer fully preventable further illness along with their families, loss of income, children neglected, and in many cases elder parents who are also being cared for someone with chronic pain. The costs are unsustainable.
    A recent study showed a marked increase in hospitalization for sickle cell pain–why? Are these people who were once well-managed, now denied pain relief from terrified doctors, and now are turning up in emergency rooms? How long will the costs continue to rise until they are unsustainable?
    All the while illegal drugs are driving overdose death rates and suicides rise as well. To make such a turn on medical standards, literally overnight thrusting patients into destabilized dangerous involuntary tapers, putting them into withdrawal while their existing painful conditions are still present, ruining the trust between doctors and patients, and inserting the government into the exam room with the blunt tool of law enforcement–this is a catastrophe! A preventable health care disaster. So many are now medical orphans having been dropped by doctors completely, unable to find new physicians willing to treat them out of fear of being raided by the DEA. Some commit suicide, and some turn to the streets looking for pain relief and end up dead. Even the president of the AMA had her own metastatic cancer patient denied at the pharmacy, and he tried to kill himself. The medical community must fight back and stick up for both themselves and their patients!

  4. As a chronic pain sufferer with bipolar I struggle daily with not committing suicide. With pain pills I rarely contemplate suicide. Without them pills I spend 90 percent of my time in a dark room praying for death. So far my only prevention is love for wife and grandchildren. So my life is so miserable. I can not even do my favorite activity signing worship songs for Churches.

  5. Untreated pain has increased suicides. Chronic pain patients are being denied pain medication. You can't get opiates from your doctor anymore because the DEA are threatening to take away their licenses for doing their job. What will calling the suicide prevention hotline going do? This is a referral service. Who are they going to refer these people to for help? There is no help.

  6. People must have some kind of retardation that they need to discuss question If chronic pain lifting A risk of suicides. Isn't it obvious that tortures make want you to escape ,like someone who jump through Window from burning house?

  7. The level of despair among chronic pain sufferers is poorly understood by those who have not experienced that; it is like taking to a congenitally blind person about the color red. Rest assured, however, conditions of our lives virtually guarantee for nearly all of us at some point of life, usually at its later stages that we will have the experience personally. Those of us who are trying to be more papal then the pope himself to be politically correct with the mob judgment expressed with the DEA regulations will be considering suicide to end it all in the absence of treatment options. Remember my words, I promise you that, I have seen it all in 40 years practicing medicine.

  8. Yes! Diagnosed at 20 with Crohn’s disease, 37 operations over the past 30 years since then, add to it 11 other chronic illnesses that were direct side effects of the treatments, and I can guarantee you that yes, chronic pain is reason enough for suicidal thoughts, quite frankly I’m surprised I haven’t killed myself already. I’ve survived three times when the doctor said I wouldn’t, but now that I have I do wish I wouldn’t have. When you face every day of your life and crippling emotional and physical agony, being nothing but a burden to all those who love you, being absolutely destroyed financially and else wise, is more than enough to make you want to take your own life. I find it almost a rhetorical question, because who would choose such exquisite pain every day of their lives? I wouldn’t, I didn’t ask for this and I don’t want it, I just wanted to end and the only way for that to happen, as if I end my life, and well and feel guilty for hurting those I love, the reality is that I’m such a burden to everybody that they would be far better off without me, as cliché as it may sound it’s true, and I hate being a burden to people, I’m the one who was supposed to be there for everybody, not the other way around, now that I’m pretty much helpless and rely on everybody for everything, what’s the point in living anymore? Just to stay alive is not living, and is not a good enough reason to live.

  9. Sure opioids is a way that we might kill ourselves, but if we were getting our normal pain medication and being treated like patients instead of suddenly finding ourselves treated like parolees we wouldn't consider it.

    Usually what happens is that the doctor dismisses us from his practice, we might get one last prescription, or have a few left from the last appointment. Either way, we know our life is over, take those opioids, wash it down with a lot of alcohol, maybe sedatives, and end it.

    It's not really a question of which came first, chicken or egg. It's rather simple; respected dignified patient being treated for health conditions will want to live, or abandoned to live in agony with no compassion and treated like scum will want to die.

  10. Chronic pain related suicide is increasing at an alarming rate. In reality doctors are now killing their patients. Many patients have legitimate chronic pain management issues. It is literally a matter of life and death. Chronic pain causes depression which can often lead to suicidal ideation. And could lead to numerous and expensive lawsuits for at least manslaughter for physicians. Which would further damage health care overall in a country where many sick people are seen as a burden on society already. And create an atmosphere of fear of physicians. When your health care professionals are perceived as inhuman psychopaths it is never good.

  11. I live in hell!!!!!! I can't sleep until I've been up for three days. I weep nonstop some days. I have a long list of problems CRPS being one of them. Opioids have been prescribed before Christ with very few problems. America has a big problem with consequences…. They don't like to deal with them. We have a ridiculous amount of drug addicts in this country, no doubt. That has nothing to do with the people living lives that would break most. Everyday we struggle with the thought of peacefully sleeping in death and these drugs are the only window of normality we have. I think they just want to get rid of the sick and dying, we cost the government a lot to keep us alive. They obviously know most of us will choose death eventually. I'll climb my crippled ass on the capital steps and slowly die with a message in hand. The handicapped in this country are pissed on more than anyone here. We have no rights and no one cares.

  12. When constant pain takes any joy or useful purpose from your life why would it not be a factor? How about just stopping the constant torture once and for all? Having no respite from pain leaves you with no other way to get relief you assholes!

  13. Not enough hear to feed the bull dogs chronic pain. More going on and Miss understood . Chronic pain mixed with the emotions and behavier today makes up rise in suicide .

  14. MIGHT be a factor? The people that are doing this are monsters. Not even the word evil can describe this. To cause torture unto a living thing. Continuous pain being, obviously, real torture.

  15. I'm an under-treated chronic pain sufferer and I'm at my wits end. fuck all you cowardly doctors bowing down to politicians and corporations to leave us out to dry. fuck you all.

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