Exploring The Link Between Chronic Pain And Suicide
http://commonhealth.wbur.org/2015/11/chronic-pain-suicide
This week’s grim report about rising suicide and overall death rates among white, middle-aged Americans contains a slim silver lining. Here it is:
The new analysis by two Princeton economists, Anne Case and Angus Deaton, suggests that chronic pain — and the opioids used to treat it — may be a key driver of the rising deaths. While the “noisy” opioid epidemic has garnered near-daily headlines across the country for several years now, the equally horrible but silent epidemic of chronic pain has not yet broken through into the nation’s consciousness. Maybe things are beginning to change.
Many people still don’t realize it, but 100 million American adults live with chronic pain, many of them with pain so bad it wrecks their work, their families, their mental health and their lives.
There are no hard data on how many people with chronic pain die by suicide every year. But there are inferences. The suicide rate among people with chronic pain is known to be roughly twice that for people without chronic pain.
(jennifer durban/Flickr)
Since there are 41,149 suicides every year in the U.S., according to the National Center for Health Statistics, it’s possible that roughly half of these suicides are driven by pain. Not proven fact, but plausible hypothesis. This would suggest that perhaps up to 20,000 Americans a year with chronic pain kill themselves, which would be more than the government’s tally of 16,235 deaths from prescription opioids every year. According to a CDC spokeswoman:
In 2013, there were 8,257 deaths that involved heroin and 16,235 deaths that involved prescription opioids. These categories are not mutually exclusive: if a decedent had both a prescription opioid as well as heroin listed on their death certificate, their death is counted in both the heroin as well as the prescription opioid death categories.
The truth, of course, is devilishly difficult to figure out with any certainty. Many people in severe, chronic pain have, and should have, opioids available. But unless they leave a suicide note it’s virtually impossible to tell if they overdose on purpose or accidentally. That’s in stark contrast to a pain patient who ends his or her life using a gun. That’s clearly a suicide, with or without a note.
In the course of researching my 2014 book on chronic pain, I heard many grisly stories. One Salt Lake City truck driver I interviewed would be dead today if his wife hadn’t walked in on him with a gun in his mouth. He had been in severe headache pain and after many visits to the ER, was repeatedly dismissed as a drug seeker, even without a medical workup. (Eventually, he was diagnosed with two brain aneurysms, bulging weak spots in a blood vessel).
I also heard about a surgeon with shingles who could find no relief for his pain and took a scalpel to his back in an attempt to dig out the painful nerves; he wound up in his own ER — as a patient. I heard of another man with ophthalmic shingles who finally shot himself because of unrelieved pain. A Boston surgeon I met was on the verge of suicide due to unrelenting pain from a rare autoimmune disease.
The anecdotes go on and on. Unfortunately, from a statistical point of view, they are just anecdotes. And unlike opioid abuse deaths, the stories of these and other pain patients rarely make the headlines.
Nor do these cases routinely make it into the reports of medical examiners and coroners, according to Utah pain specialist Dr. Lynn Webster, writing in a recent issue of Pain Medicine News.
In this week’s Princeton study, the lead author, Anne Case, was particularly interested in the role poor health might play in suicide because, as she told The New York Times, she herself has suffered for 12 years from disabling and untreatable lower back pain. In her research, Case discovered that middle-aged people, unlike the young and unlike the elderly, were reporting more pain in recent years than in the past. One-third of people in this group had chronic joint pain in recent years and one in seven reported sciatica.
The dismal situation with chronic pain — and the potential link with suicide — is unlikely to improve until the federal government takes the pain epidemic seriously. While the government spends $2,562 on research for every person with HIV/AIDS, it spends only $4 for every person with pain.
Clearly, chronic pain needs more attention and more research dollars. After all, it is the main reason Americans go on disability.
And it appears to be driving growing numbers of Americans to kill themselves.
Judy Foreman is the author of “A Nation in Pain: Healing Our Biggest Health Problem.”
Filed under: General Problems
Gary, will you be posting this onfo on the CDC Guidelines comments? I would be great if you will.
Doug – such a good point you’ve made. The media isn’t doing much with this vey subject and this message needs to get out now. There are plenty who don’t know this information. I hope Steve will pick up on this and do an article to help spread the proper information. I wish the media were flooded with it right now while the CDC Guideline comments are still open. I do research on pain and opioids so I read about three to four hours a day. The media is absolutely flooded with putting the blame on doctors, ERs, and patients for the so-called “epidemic” in opioid overdosing, and that our pain meds lead to heroin abuse and death. I was a publicist and journalist for a long time and I suspect there are press releases or private calls going out to media to run these articles. I see many new ones varied around the country everyday. If they are not in the national spotlight, smaller newspapers, TV and websites are publisihng crazy numbers and it’s just not stopping. People believe what they read and this is hurting our cause in such a way that I don’t think we’re going to have much luck in the near future.
Thanks for posting this Steve,
Those of us who testified at a recent FDA hearing on the dangers of epidural steroids have been thinking that this has been a thinning of the herd for years. The U.S. healthcare system has an epidemic on their hands and the public does not know it. Were you aware that the hoplessly incurable spinal cord disease adhesive arachnoiditis can be caused by an epidural steroid injection that does not puncture the spinal cord? I would not be suprized if you didn’t but a recent medical study backed by MRI images out of Belgium shows that it is not only possible but can develope in as little as eight weeks. A bombshell for the medical community especially when you consider that millions of Americans have gotten epidural steroid injections for back pain. Can you imagine what has been happening behind the scenes when patients started showing up with burning leg pain, hot wires pulling, deep bone pain and other bizarre pain symptoms which are classic adhesive arachnoiditis symptoms all over the country? Did they admit that there was a problem? No because it was a lot easier to misdiagnose a patient with fibromaligia or failed back syndrome anything but admit your doctor has given you a hoplessly incurable disease. And now that all these incurable patients are showing up with suicide level pain how are they treating them? Calling them addicts and blaming the opioids for their problems anything but admit the truth because it is easier to exterminate a whole generation of Americans than it is to make public a epidemic of disability and pain caused by the very doctors we went to for help with back pain. If you have had a spinal injection and now have burning pain or other bizarre sensory issues after ESI you are likely a victim of this man made epidemic and unless you speak up will no doubt end up being a part of this latter group who took their own lives when treatment was no longer an option available to them.
Until Big Life Insurance is required to pay benefits out for suicide, it will continue to look as if opioid overdose is accidental instead of international.
Suicide is still death caused by disease, whether it is because of mental illness or pain that can no longer be lived with. Whether it’s by rope, gun or pill, suicide death is still caused by either an illness or a crime.
The definition of suicide is basically, self inflicted death, but if an individual drives another person to suicide by bullying them, that bully would now be guilty of homicide. If a person were to die because they were denied food or water, this is considered neglect and because the person died also a homicide.
My point is, every suicide and so called accidental overdose should be investigated as if it were a crime, then the actual cause of this death published so the public can form their own opinions.
Right now the government has absolutely no idea how many chronic pain sufferers have taken their own lives by using their medications as the tool to commit suicide.
Officials automatically assume that pharmaceutical deaths are accidental unless the victims leave a note and label them that way. Now their best solution to prevent these miss labeled deaths are to remove the medications without really knowing if the death was accidental or intentional.
Yet the public is not informed that behind closed doors the ACTIVE INGREDIENT in all medications can be up to 40% less, [this is huge]. And what about our right to know what we are ingesting ? They could care less about death and injury due to the fact that the “franken-meds” ingredients are not disclosed at all. This is a controlled, sadistic, and unethical, inhumane and means of controlling both the population and human ABILITY to fight for our rights and CHANGE.
How many times has this propaganda been played-out. It’s a fact the CIA brought in illegal drugs to profit the gov-greed. I bet on my miserable life that if OBAMA and anyone with status gets sick and is in chronic pain, they will be handed the menu of opiates w/o question or suspicion. We commons are just unable to get it together to take back our government. Leave suicide alone. I will put myself “to-Sleep” in a heart-beat than be at the mercy of these sadists.
It’s been proven that JFK was a chronic pain sufferer almost his entire life. He was prescribed a lot of medications and he and Jackie were trained in giving him injections of some pretty strong stuff. He is considered one of the best Presidents ever and needed narcotics just to get through the day. Just maybe history should be explored to see how many other important people had to use medications to simply live day to day.
Steve, great article with good, noted research. You are really an immense help to the pain community. I am a chronic pain patient and a freelance writer, and I am currently doing research on chronic pain, treatments and opioids. If I didn’t have my Oxycodone and Fentanyl patches, I would also need a gun. Even with the (very helpful) meds, I am lying in bed because I feel like I’ve just been run over by a truck with eight wheels. Keep up the good work!