Nearly 9% of people who died by suicide in 18 states from 2003 to 2014 had documentation of chronic pain in their records, and they were much more likely to test positive for opioids at the time of death than those who died by suicide and didn't have chronic pain, a study found.
Researchers from the CDC's Division of Violence Prevention in the National Center for Injury Prevention and Control analyzed data from 18 states participating in the National Violent Death Reporting System (NVDRS) for at least one year from 2003 to 2014. The NVDRS details characteristics of violent deaths, including suicide, and the circumstances identified as directly contributing to the death. Findings were published Sept. 11 by Annals of Internal Medicine.
Among 123,181 suicide decedents included in the study, 10,789 (8.8%) had evidence of chronic pain, and the percentage increased from 7.4% in 2003 to 10.2% in 2014. The most common categories were spine pain (24.4%) and musculoskeletal pain (20.8%). The most common conditions were back pain (22.6%), cancer (12.5%), and arthritis (7.9%). More than half (54.4%) of decedents with chronic pain had one medical condition, 15.7% had two conditions, and 5.7% had three or more conditions, the study said.
Firearms were the common mechanism of death among decedents with chronic pain (53.6%) and those without it (51.4%), followed by opioid overdose (16.2%), other poisoning (13.3%), and hanging or suffocation (12.9%) among decedents with chronic pain versus hanging or suffocation (25.6%), other poisoning (11.8%), and opioid overdose (3.9%) among those without chronic pain. Of decedents who had drug testing, 51.9% of those with chronic pain, but only 18.8% of those without, tested positive for opioids; 47.2% of those with chronic pain and 31.7% of those without tested positive for benzodiazepines.
More than half (51.7%) of suicide decedents with and 44.1% of those without chronic pain had a known mental health condition, with depression being the most common diagnosis in both groups. Most suicide decedents were not known to have problematic substance use. Approximately 20% of decedents with chronic pain and 31.2% of those without it had suspected alcohol use at the time of death. Abuse of substances other than alcohol was noted in 17.6% of decedents with and 14.8% of those without chronic pain.
Many decedents with and without chronic pain left suicide notes (41.4% and 32.8%, respectively), had a history of suicidal thoughts or plans (39.5% and 31.1%, respectively), had a history of suicide attempts (21.1% and 19.8%, respectively), or disclosed their intent to die by suicide (33.0% and 27.4%, respectively). A random sample of decedents with chronic pain who left suicide notes found 67.4% of notes with reported content indicated that a pain condition or pain itself played a role in their decision to die by suicide.
“Providers caring for patients with chronic pain should be aware of the potential increased risk for suicide, and more effort may be needed to diagnose, manage, and treat chronic pain and comorbid mental health conditions,” the authors concluded.
An accompanying editorial drew attention to the frequency of pain in the suicide notes. “This observation highlights the need to improve pain treatment, not only for the direct effect on pain and functioning but also as a method to raise hope in persons with chronic pain.”