Suicide is the dark side of medical care. It’s a risk that always shadows patients who are dealing with overwhelming issues associated with illness or the effects of a traumatic injury. Patients who suffer from chronic pain know it as a pain that is a continual feature of daily life; it presents a constant drag on one’s emotional and physical well-being. The relentless nature of chronic pain is what can drive some patients to consider suicide, and that is why it’s critical for healthcare professionals to know the danger signs in patients who suffer from ongoing pain.
The Significance of Major Depressive Disorder
A large percentage of patients (close to 50%) who are treated by primary care providers do suffer from chronic pain, and this condition is a major factor in the incidence of major depressive disorder. Major depressive disorder is characterized by at least 5 key symptoms, including: insomnia, lack of feelings of pleasure or of interest in life, loss of appetite, fatigue, indecision or trouble concentrating, feelings of life being worthless, a feeling of slowness and lack of normal energy, and thoughts of suicide.
Obviously patients who suffer from major depression are at increased risk of suicide and should be closely observed. The onus for assessing risk in a patient dealing with chronic pain generally falls to the primary care providers, as well as family members who are involved in the patient’s care. A sensitivity to the patient’s moods and any changes in symptoms is key to assessing suicide risk in a patient who suffers from continual pain.
Knowing the Key Factors in Suicide Risk
Patients who live with chronic pain and then descend into major depression are obviously at risk of suicide. These patients, who may find their depressive symptoms increasing as they deal with a deteriorating health scenario associated with ongoing pain, are at greater risk for suicide due to three major factors. These key factors include a history of sexual abuse in childhood, a family history of major depression, and a lack of social involvement. As depression increases, some patients may become increasingly socially withdrawn and begin to feel that they are a burden.
Other factors that can lead to suicide risk, especially in patients who have chronic pain, are job loss, and losses (like a death in the family or divorce) that lead to feelings of overwhelming sadness. Unfortunately, all of these factors can lead to a high risk of suicide in the patient. Patients on large doses of medication are also at a higher risk of suicide, as opiate drug use can more easily lead to unintentional overdose in the patient.
The Transitory Nature of Suicidal Thoughts
Even as the chance of suicide increases for patients who have high risk factors and who are experiencing depression, it’s important to remember that suicidal thoughts are often transitory. A patient experiencing a “bad day,” with heightened pain and feelings of isolation, may be able to get past the thoughts of suicide if they receive care and become more socially involved. What’s critical in treatment is that caregivers stay aware of heightened areas of risk and respond quickly to alleviate symptoms.
Luis Fandos is a certified anesthesiologist based in New York.