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. 

Sources:

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

 

 

 

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