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Why We Need to Include Chronic Pain in Suicide Prevention

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When we talk about suicide, we usually talk about it in terms of mental health and mental illnesses. She was depressed. He was “struggling.” She had mental illness for years.

When we talk about chronic pain, especially in light of the opioid crisis, we often focus on the clinical, the diagnoses. The “risks.” Her doctor should never have written that prescription. Opioids are “no good.” Why couldn’t she just take ibuprofen?

What we need to do is start talking about the intersection between suicide, mental health, and chronic pain. We need to stop suggesting chronic pain is just something you “suck up and deal with” and that suicide is just a matter of someone being “sad” and “not strong enough.” We need to talk about the very real fact that chronic pain is a unique factor that can lead to suicide — and the fact that we’re not doing enough to stop it. Leaving people with chronic pain out of the suicide prevention discussion can be, quite literally, deadly.

It’s not just anecdotal evidence that suggests chronic pain can lead to suicidal thoughts and suicide. Research, too, backs this up. A study published in the Annals of Internal Medicine found that 10 percent of the more than 100,000 suicide deaths included in the study occurred in people with chronic pain. Though the study can’t prove that chronic pain was a contributing factor, lead author Emiko Petrosky, medical epidemiologist with the Centers for Disease Control, did note that mental health issues were more common among those with chronic pain, and that the proportion of suicides by people with chronic pain had increased from 7.4 percent in 2003 to 10.2 percent in 2014, as the number of people with chronic pain also rose.

A study of 1,871 chronic pain patients found that they had a 3.76 increased risk for suicide attempts, and another study of 2,674 people with 19 chronic conditions found that the risk of suicide was increased for 17 of these conditions.

The answer isn’t that people with chronic pain “aren’t strong enough” and just need to “toughen up,” like they’re often advised to do. If you don’t have chronic pain, imagine the worst pain you ever felt. Maybe a broken bone, or stomach bug you caught on vacation once. Now imagine that pain is with you every day. It never fully goes away. Imagine how difficult it would be to work, see your friends, go grocery shopping, and spend time with your kids. Imagine the strength it would take to get through each day. That’s what people with chronic pain deal with every day, sometimes for years. So no, this isn’t a matter of patients needing to “toughen up.” They’re already tough.

It’s a matter of what chronic pain takes away, and what the medical community and society at large doesn’t give back. Until we recognize where we’re failing chronic pain patients, and how these failures contribute to a patient’s mental health, the suicide rate may only increase.

The first place chronic pain patients are failed is, too often, the doctor’s office. Chronic pain is often invisible and difficult to diagnose, so many doctors’ first “suggestion” is that their patient’s symptoms are due to anxiety, depression, or the pain is “all in your head.” Patients often shuffle between doctors for years before someone takes their pain seriously and looks for the root cause.

The treatment options they’re left with likely don’t include some magic solution that will fix everything. Sometimes it takes a combination of medications, physical therapy, diet and lifestyle changes, meditation techniques, and surgery — but it’s important to acknowledge that not every treatment works for everybody. And even if certain methods work, insurance might not cover them.

Patients whose chronic pain limits their ability to work and socialize often feel unsupported outside the doctor’s office, too. Not everyone is approved for receiving disability payments, especially if their illness is invisible or misunderstood, like fibromyalgia. Restaurants, shopping centers, and public transportation are not always accessible. Friends may slowly fade away when you aren’t able to spend time together due to your pain. The current opioid crisis means people with chronic pain are continuously hit with messages and policies that attack their access to medications and assume they’re abusing them. In reality, they’re taking them responsibly and those medications might be the only thing that actually helps.

It’s understandable that people with chronic pain may feel depressed and anxious about all these challenges they’re enduring. This is where reaching out for mental health care is so crucial, and can save a person’s life — but chronic pain patients might hesitate. So many have already been told “it’s all in your head” and been dismissed by doctors and even friends and family who didn’t believe their pain was really “that bad.” You might not feel comfortable telling your doctor you’re having suicidal thoughts when perhaps that same doctor has already questioned whether or not your pain was “real.”

The presence of mental health issues should never rule out diagnoses and treatment of concurrent chronic illness. A good doctor will know this. Any doctor who doesn’t isn’t worth your time. But when your pain has already been doubted, and you’re already feeling like no one’s really on your side, reaching out for help and talking about your mental health may feel like too great a risk to take — even though reaching out and getting help for your mental health can save your life.

Once we acknowledge the unique challenges of chronic pain that can lead to suicidal thoughts, then we can go to work on what might bring the suicide rate down. We need more funding for research into chronic pain disorders and treatments. We need to elect politicians that understand the nuance of opioids — that you can’t simply take them away from patients who have always used them responsibly (hint: many chronic pain patients) without offering viable alternatives. We need to recognize that we do not offer enough support to people with chronic pain and that far too many patients feel like they’re drifting alone without a life raft, that there’s no one who can help them.

This is the message you deserve to hear if you have chronic pain: You matter. You deserve to be on this Earth. You’re not a “burden” or “less than” if you can’t work or go out like you used to. It’s not your fault you have chronic pain. You need to understand that doctors, lack of resources, politicians, and friends who faded away are what failed you. You did nothing wrong and deserve better than to feel like suicide is the only answer. There are mental health and disability-specific resources out there to help you.

Society needs to do a better job of taking care of you. Until then, any efforts to combat suicide have a responsibility to acknowledge what you’re going through, and that your life matters.

Originally published: September 15, 2018
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