Migraine, Chronic Back Pain Tied to Suicide Risk
Hopelessness, disability may play a role in feelings of despair, study finds
"It's not a standard question: 'Are you in pain?'" Ritchie said. "I would ask, 'Are you in pain?,' or 'Is pain an issue for you?'"
Psychogenic pain increased people's risk of suicide the most, followed by migraines and back pain. Psychogenic pain is chronic pain caused or exacerbated by mental or emotional problems, and Ilgen said it is a rare and not well understood condition.
"We think that's not so much about psychogenic pain per se, but the fact that the pain itself is poorly understood and may be poorly managed," Ilgen said. "There's not a clear treatment plan for that type of pain. It's likely that patients with this type of pain may be frustrated with their care and more hopeless and more at risk for suicide."
Hopelessness also could play a part in the elevated risk of suicide for migraine and chronic back pain sufferers -- two common problems in the United States. Back pain, for instance, is the second most common pain complaint among Veterans Health Administration patients, behind only arthritis.
"Patients with these pain conditions also may be more likely to feel hopeless and to have impairments in occupational or social functioning that could lead more directly to suicidal thoughts and behaviors," according to the study.
"Negative expectations about one's ability to effectively manage or treat pain could lead to suicidal ideation, and these effects might be greatest for certain conditions, such as psychogenic pain, that do not have clear or effective treatments and may be stigmatized," the researchers said.
Disability also could be a factor in the increased suicide risk, particularly for people with back pain who used to be healthy and active, Ritchie said.
Ilgen said it is not known whether there are unique warning signs of suicide for chronic pain patients. He urged family and friends of patients to keep a close eye out for standard warning signs, such as intense depression, expressions of hopelessness, statements about suicidal thoughts or plans, or any indication that the person is not oriented toward the future.
"My best recommendation is to encourage the patient to reach out for professional help," Ilgen said. "Ask about their suicidal thoughts. Don't just skirt the issue; directly ask."