When chronic pain kills

One of the "interesting" things that have happened to me since I started to leave chronic pain behind me is that people have started to recognize my illness. People who had denied it for years, when they saw me go to the gym twice a week, run, treat myself with medicines "never heard of" and literally become someone else, began to think (more than anything else to understand) that I was "Really sick".

At that point, even the most unsuspected, not only began to ask me for information for the friend who is suffering or (even) for themselves, but also to tell me about those acquaintances of theirs who, for years, sought help because they suffered from terrible pain. and that, in the end, unable to find it anywhere, they decided they had had enough.

I had always thought that chronic pain could ruin a life to the point of suicide. I myself had thought about it, for about thirty seconds, in the summer of 2003, looking at the pavement from the second floor of the house. Now I had some more empirical data, which wasn't just about me.

Surely it is not pleasant to talk about suicide. It's not a topic to talk to. But generally, problems are not solved by ignoring them.

We, of chronic pain, kill each other. I don't feel like turning a blind eye.

In fact, unless there are specific underlying pathological conditions, chronic pain "in and of itself" does not die. It is possible that a predisposition to cardiovascular disease develops, probably caused by the prolonged anxiety and stress to which those suffering from persistent pain are exposed, but this is a condition that can be managed with the appropriate strategies.

Other factors related to increased cardiovascular risk, cancer and lung disease, often also affecting chronic pain sufferers, are too high BMI, inactivity, poor diet, but they are all factors related to lifestyle, which suffers the effects negative of a series of prejudices on chronic pain (in particular the need to reduce movement, which is deleterious), not on chronic pain itself: by improving the lifestyle, one returns to "normal" ranges.

In short, I don't think I have to explain here what it means to live with persistent pain but, to summarize, it means carrying a load of pain that, in the long term, physically and psychologically is simply devastating. First the body is stolen, then the psyche, sometimes the whole. If he eats it. It takes life. Point. And you can get to contemplate suicide.

Suicide rates are more common among people with persistent pain.  Risk factors in this population can generally be conceptualized in terms of two categories. The first includes factors that are not limited to pain patients but are associated with suicidal tendencies in general. The second category groups specific risk factors for people with pain. Some of these are difficult or impossible to change, such as the duration of pain, or where the body is affected. Others, such as the intensity of pain, the tendency to catastrophism, functional interference, poor self-efficacy, can be improved with appropriate interventions (and this could be considered good news).

Although rarely discussed, suicide in people with chronic pain often occurs. There is no concrete data on how many people with chronic pain die by suicide every year. But there are some assumptions. It is believed that on about 40.000 people who succeed in their suicide attempts every year in the United States, at least from the 10 to the 15% are people suffering from chronic pain. The truth, of course, is devilishly difficult to understand with certainty (I don't want to dwell on dissertations on the subject, but we don't have the data of people who don't leave letters explaining their motives and often it is not possible to frame opiate overdoses as intentional acts, etc.).    

Since individuals with chronic pain are at least twice as likely to report suicidal behavior or commit suicide, it is of the utmost importance to identify which risk factors contribute most to the increased risk of suicide. There is strong evidence that chronic pain itself, regardless of type, is an important independent risk factor for suicide. The only socio-demographic factor found associated with suicide in individuals with chronic pain is related to unemployment and disability. Depressive symptoms, anger problems, harmful habits (e.g. smoking, alcohol abuse, illicit drugs), adversity in childhood or adulthood, and family history of depression or suicidal tendencies have all been identified as general risk factors.

Regarding pain-related factors, sleep problems, low mood, concomitant conditions of chronic pain, and more frequent episodes of intermittent pain, all were considered to be predictors of suicide. Unexpectedly, the characteristics of pain (e.g. type, duration, intensity, severity) and physical state do not appear to be related to suicide risk. Psychosocial factors (for example the sense of mental defeat, the tendency to catastrophism, despair) are more significant, associated with suicidal outcomes.

A large number of these factors are susceptible to change through targeted intervention, underlining the importance of comprehensively assessing chronic pain patients at risk of suicide, while also incorporating a suicide prevention component into chronic pain management programs.

The plight of chronic pain patients, and their potential link to suicide, is unlikely to improve until the chronic pain epidemic is genuinely taken seriously by implementing truly effective strategies that do not rely on prehistoric treatment of the problem. .

People living with chronic pain are the reason why increased care funding is needed to manage chronic pain, at all levels, starting with the training of health personnel (and others). The weight of pain often exceeds the human will to live, too often not because research is lacking, but because of a dramatic lack of skills on the part of those who should take charge of the health of patients, who are left to themselves, lives without lives, in which the pain leads to a disintegration of the lived, of the relationships, of the personality, with very serious repercussions, which should no longer be ignored. 


When pain kills - chronic pain and chronic diseases by Chris Williams on Body in Mind read it here

The Painful Truth, by Lynn Webster

A Nation in Pain. Chronic Pain and the Risk of Suicide by Judy Foreman on Psychology Today

Chronic pain and suicide risk: A comprehensive review, by Melanie Racine Neuro-Psychopharmacology and Biological Psychiatry PubMed # 28847525

Testing the Interpersonal Theory of Suicide in Chronic Pain by Wilson KG, Heenan A, Kowal J, Henderson PR, McWilliams LA, Castillo D on Clinical Journal of Pain PubMed #27768608

Remission From suicidal Ideation Among Those in Chronic Pain: What Factors Are Associated With Resilience? by Fuller-Thomson E, Kotchapaw LD on The Journal of Pain PubMed # 30979638




Chronic pain does not exist

We constantly hear about cancer, diabetes and heart disease. I think it's good. Not that you love hearing about diseases, of course, but if something is talked about, it means that you are not sweeping it under the rug pretending that it does not exist. Talking about it probably also means more prevention, more research.

Obviously, the perception that results is that cancer, diabetes and heart disease are the great evils of our time. What if I told you that things are not exactly like that? It is estimated that around 1,5 billion people worldwide suffer from chronic pain. That's a huge number, more than those with cancer, diabetes and heart disease combined. This data is obviously a projection made in the light of some surveys conducted in Europe, the USA and Australia and Asia. It affects at least one adult in five, leaving out children and adolescents. Studies conducted at European level confirm that persistent pain has a significant impact on daily life, sociality and the quality of life of those affected.

Between half and 2/3 of those who live with persistent pain, their ability to rest normally, move, participate in social activities, drive a car, have a normal sex life diminished. Not to mention that one in four people say that relationships with friends or family have thinned or interrupted. One in three is less able, or completely unable, to maintain an independent lifestyle. One in five is depressed due to pain. 17% suffer so much, at times, that they would like to die. Some actually kill themselves, but the study doesn't say how many. 39% of respondents feel that their pain is not being managed properly and that doctors do not consider pain a problem. Chronic pain, not wanting to consider the psychosocial aspect, because for now we assume that we are heartless and we don't care about the suffering of others, has a tremendous economic impact.

Let us reason as if we were Ebeneezer Scrooge: lumbar pain alone is one of the most impactful economic burdens in developed countries. In fact, it implies costs for treatment, for welfare, but also for the absence from work and the decline in performance of those who have to take on the tasks of absent colleagues, loss of earnings for companies and for the patient, decrease in earnings and, therefore, the possibility of spending for those who eventually find themselves in the position of having to support the relative forced inactivity due to chronic pain. Research also shows that people with persistent pain are more at risk of losing their jobs and often unable to work outside the home. In short: we are talking about an apocalyptic problem, with tremendous social and economic implications.

So I think the legitimate question, without using bad words, is: "Why is the global pathological burden of chronic pain underestimated?" I've been looking for some answers. The answers that are there, when they are found, make you shiver. In this regard, a simple but rather interesting document came into my hands. A "Fact Sheet", entitled "Unrelieved Pain is a Major Global Healthcare Problem". Persistent pain is not diagnosed and is not treated because it is considered "psychosomatic", fruit of depression (I have already become a pressure cooker) that often afflicts those who suffer from chronic pain, therefore lacking a real organic cause. It is not diagnosed because treatments are considered futile. It is not diagnosed because pain is inevitable. It is not diagnosed because patients are old and have little to live, or are they too small and some still believe that children feel no pain, or that third degree burns are painless. Primarily, there is still an unacceptable ignorance of the subject. And I'm not saying that. The World Health Organization says so. Including the reasons why chronic pain is underestimated, which are fundamentally driven by a variety of goat biases (forgive me, I've been kind so far), What are the obstacles to the evaluation and treatment of chronic pain? I have a suspicion, but let's see what the "Fact Sheet" I have on hand tells us.

The first culprit is, ladies and gentlemen, ignorance above. Lack of knowledge or awareness. This problem does not only concern the poor patient or his family, who perhaps are florists and would have every right not to know a damn persistent pain, but also the health professionals, therefore those who should treat him, the poor patient and who , I suppose, I add, they should at least know more about him. Furthermore, we consider that in Europe, one in four patients with moderate or severe pain reports that the treating doctor has never asked questions about the pain, did not think he had pain problems and, in any case, even if he asked for information, we he paused briefly and was unable to provide a solution. That good news. Although the availability of opioid analgesics to relieve cancer pain has increased even in developing countries, thanks to the efforts of the World Health Organization, cancer pain is not the only severe persistent pain that exists and opioids do not exist. they are the only drugs needed to treat it, so most people with persistent pain remain without adequate drugs worldwide.

And what is done to change this state of affairs? We educate ourselves. You study, you learn. Such as? By changing university programs, for example. Reading scientific journals. Going to training courses. By ceasing to consider themselves intellectually and morally superior to their patients, because a degree in a medical health profession does not ennoble man.

It's a big problem, I'd say. And I don't think the World Health Organization and the International Association for the Study of Pain have been very successful.

The Fact Sheet I am reading is from 2004. It was produced on the occasion of the First Global Day Against Pain by the International Association for the Study of Pain - IASP and the European Federation of Chapters IASP - EFIC, with the co-sponsorship of the Organization World Health. Old news? In terms of time for sure. If we rely on the results, frankly, the contents seem very valid to me.

Something is moving, it's true. But there is still a tremendous disconnect between clinical practice and scientific research. And it's not admissible. We need to keep talking about pain. There is nothing ignoble or complaining about doing this. It would be like not talking about cancer, because it is not dignified or makes us sad or it is not "manly". To me it would seem just incredibly stupid.





Unrelieved Pain is a Major Global Healthcare Problem, Fact Sheet, IASP - EFIC





The beginning of (my) story

I state, in my defense, that I love my mother madly. She is a brilliant woman, a crossing between Alice in Wonderland and Piperita Patty. My mother is an artist. Which means that he has a very refined taste when it comes to compositions of flowers and watercolor painting or furniture, but everything that is not figurative art is beyond his interest: the wardrobe, for example. As long as it is his, there are no particular problems as far as I'm concerned. But when it comes to my well, it was hard to be twelve and put it on a counterculture militant. When my classmates hid in Energie bomber jackets, flared jeans and Kikers, I was doomed to be a budding intellectual. They made fun of me for my milk-white skin, they called me "the dead". No, I don't get a tan. Never. It is not a habit. I am like that. It is called phototype 1. If we add to this the wardrobe, we understand how my desire to disappear increased, but became more and more an unattainable desire. I had the gene of being against the grain in me, but at twelve I didn't know what to do with it. It was Saturday. I think it was spring. After school they started making fun of me about the color of my skin. The oversized sweater didn't help me have courage. I had black leggings. Black ballerinas. I don't know what exactly happened. I know that the bully-head came up in front of me and teased me, then I fell. The backpack, full of books, with its exorbitant weight, dragged me backwards, and I remained there, like this, on the ground, in the middle of the road, for a time that I cannot define, I presume fainted. I don't know what exactly the phrase “seeing the stars” comes from, which is used to describe being hit by a strong and sudden pain: the fact is that I have seen the stars or rather, the stars (here they are!). And it wasn't a bright flicker in front of my eyes: I just took a walk in the middle of it, in a midnight blue tunnel. And from that day my long and very complicated love story with chronic pain began. Why do I call it a love story? Because our relationship was a long life, mine, and it was difficult, made up of very long moments of mutual misunderstanding, then somehow it blossomed, when I found a way to speak his language: it may seem delusional, but it's not too bad. You will understand this by reading. After all, I cannot say that I hate my past life: it was my life.

When I woke up, after my astral walk (it should be said), there was no one around me anymore: I was alone, lying in the middle of the road and I was suffocating. I remember having raised myself from the ground by taking my arms off the straps of the backpack, leaving it there, and having walked gasping into the arms of a perfect stranger who, somehow, massaging my back and hugging me, managed to bring me back to the living. I did not feel the victim of an act of bullying, in '92 I had not even heard of it, but only a perfect idiot: a simple, further, living confirmation of my clumsiness.

Here, to me the chronic pain touches from that epic fall, of which, essentially, it has not imported a pipe to anyone. I had fallen. Everyone falls. I played with Barbie and I had atrocious back pain, but they told me they were the pains of growing up. It didn't seem to me that none of my classmates suffered like this, moreover in an area hit by a crazy blow, but I took the explanation for good. In short, it seemed to me that it was my grandmother who had back pain and I certainly didn't have my grandmother's age, but I made the interpretation go well.