Addressing the Connection Between Chronic Pain and Suicide

I recently had a doc say to me, “Fibromyalgia won’t kill you.”

I know this. I’ve dealt with this condition most of my life.

I shot back, “Yeah, I know. The other half of that statement is, “But it will make you wish you were dead.’”

Let’s just say that particular doctor’s visit didn’t go well.

The reality is that there are many chronic pain conditions and illnesses that in themselves, are not deadly. That part is true. But the damage that these conditions cause to our lives, livelihoods, bodies, relationships, and even our daily interactions can and do place individuals with chronic pain and chronic illness at a higher risk for suicidality.

A recent article published by the American Chronic Pain Association reports that a survey they conducted showed that 47 percent of the respondents (chronic pain patients) have contemplated suicide. Given that an estimated one in five American adults are living with chronic pain, one would think that there would be more attention given to what is such a high risk group and such a large part of the population.

And frankly, even more concerning is that the push from the CDC and other federal entities to limit the access of opiate pain medication may have had an increasing negative impact on suicide rates. In short, since chronic pain warriors are having more difficult accessing the medication they need to control their pain, anecdotal reports have suggested the suicide rate among this population may be rising.

Why are chronic pain warriors at high risk for depression and anxiety?

There are a number of factors that can contribute to depression and anxiety, including not enough sleep (or enough restful sleep), isolation, not getting enough Vitamin D, some health conditions, a chemical predisposition to mental health challenges, and many others. For instance, if someone with fibromyalgia has sleep disturbances, this could not only cause an increase in the level of pain, but it’s likely to impact the person’s ability to interact with the outside world (leading to increased isolation), and may start a cycle of poor sleep due to pain leading to worse sleep and so on.

And then, there is the stigma. This comes from everywhere. It’s in the judgment of every person who watches me get out of the car when I have to use an accessible space, to the coworkers who wonder why I called in sick, to the doctors who tell me I shouldn’t feel this bad (when they themselves can’t begin to fathom what I feel). It’s from well-meaning but misdirected individuals who offer the “cure” their brother’s second wife’s cousin is selling this week for all conditions. Maybe we have family and friends who we feel we’re asking too much of or have become a burden to. The stigma is isolating as well.

And, of course, there is stigma in reaching out for help with mental health. There are the lack of resources for individuals reaching out for mental health. In addition, while there is an increasing understanding of the impact of chronic pain and illness on mental health, this is still a growing movement, so the professionals who are competent in chronic pain tend to be scarce.

How do we address this, in my opinion?

The good news is that there is a growing trend (thanks Medicare!) to have patients of all backgrounds complete a Patient Health Questionnaire (PHQ) when they see their PCP. The PHQ is a screening tool for depression, and it also screens for suicidality. This can be a very useful tool, and since Medicare implemented requirements for screening tools to be utilized as a part of patient care, other insurance companies are noticing and following suit.

Social media has also been a great place for chronic pain warriors to find support from others living with chronic pain, and some areas have in-person support groups. These can be great resources.

Ultimately though, care for people like me has to be holistic and address my mental health needs as well as my physical health needs. This means all of the systems of the health care system need to come together to treat chronic pain warriors as the whole person that they are (chronic pain and all). I think it requires an approach that is common sense in many ways, but is rarely put into practice: treat the whole person, not just the problem area.

And finally, I think medicine and the CDC need to realize that there is an appropriate place for opiate pain medications in chronic pain management. It’s not necessarily the whole treatment plan, but it can be part of a comprehensive treatment plan: and for many people, it’s a necessary part of treatment. It may be the only thing keeping someone going on with the fight against their pain.