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The pain suicidality association: a narrative review
David A Fishbain1, John E Lewis, Jinrun Gao
1Department of Psychiatry, Miller School of Medicine, University of Miami, Miami, Florida, USA; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA; Department of Anesthesiology, Miller School of Medicine, University of Miami, Miami, Florida, USA; Department of Psychiatry, Miami VA Medical Center, Miami, Florida, USA; State Farm Insurance, Bloomington, Illinois, USA.
Pain Medicine (Malden, Mass.)
|July 5, 2014
Summary
This review confirms a strong link between pain and suicidality, including ideation, attempts, and completion. Evidence supports this association in both chronic pain patients and other populations.
Area of Science:
- Psychiatry
- Pain Medicine
- Public Health
Background:
- Suicidality, encompassing suicide ideation (SI), suicide attempts (SAs), and suicide completion (SC), is a significant public health concern.
- The relationship between pain and suicidality has been investigated, but a comprehensive review of recent evidence is warranted.
Purpose of the Study:
- To systematically review and synthesize recent and past evidence on the association between pain and suicidality.
- To evaluate the consistency and strength of evidence supporting the pain-suicidality link across different populations and types of suicidal behavior.
Main Methods:
- A narrative review of 58 research reports was conducted.
- Studies were categorized by suicidality outcome (SI, SA, SC) and population (acute pain patients [APPs], chronic pain patients [CPPs], other).
- A vote counting method assessed the proportion of studies supporting the association, with consistency rated using Agency for Healthcare Research and Quality guidelines.
Main Results:
- Consistent evidence (A rating) was found for the association between pain and SI, SA, and SC in non-pain patient groups.
- Consistent evidence (A rating) also supported the association in CPPs for prevalence exceeding control groups.
- Subgroups controlling for behavioral confounders in non-pain patients also received an A rating, and new predictor variables for suicidality in CPPs were identified.
Conclusions:
- The reviewed studies provide solidified evidence for a significant association between pain and various forms of suicidality.
- This association is evident in both chronic pain patients and individuals without chronic pain conditions.
- Findings highlight the critical need to address pain in the context of suicide prevention strategies.