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Pain a High-Risk Factor for Suicide

People affected by certain mental illnesses have substantially increased risks for developing pain, and some diagnosable mental disorders feature pain as one of their primary symptoms. In a study published in July 2013 in the journal JAMA Psychiatry, a multi-institution research team examined the connection between pain and the chances of dying from suicide. The members of this team concluded that, in combination with diagnosable mental health problems, the presence of serious pain significantly increases suicide risks.

Pain Basics

Physical pain occurs when specialized nerve cells in the body send certain signals that the brain interprets as hurtful in nature. On an evolutionary level, these signals provide a high degree of protection by telling a person that he or she is in some sort of physical danger. However, because of the extremely complex interaction between the human brain and body, an individual can potentially misinterpret the significance of pain signals in the nervous system or experience pain in the absence of a physical source for that pain. Some people develop short-term forms of pain known collectively as acute pain, while others develop long-term forms of pain known collectively as chronic pain.

Pain and Mental Illness

Mental health professionals refer to pain that’s linked to emotional/psychological problems as psychogenic pain. In some cases, psychogenic pain may be entirely mental in origin; in other cases, it may stem from a combination of mental and physical factors. At one time, the American Psychiatric Association (the organization responsible for creating the U.S. standards for mental illness diagnosis) attempted to strictly separate purely emotional/mental forms of psychogenic pain from the forms that also contain a physical component. However, as of 2013, doctors can consider both forms of pain when making their mental health diagnoses. Most people who experience partially or fully unexplained physical pain as their primary symptom of mental illness have a condition called somatic symptom disorder. This diagnosis replaces a number of previously defined conditions, including pain disorder, somatization disorder and hypochondriasis (hypochondria).

A number of other mental disorders sometimes include substantial symptoms of physical pain. The prime example here is depression, a collective term used to identify major depression, persistent depressive disorder (formerly called dysthymic disorder) and several other related conditions. A depressed person may experience pain in forms such as headaches, cramping muscles or aching muscles. The complex effects of depression make it hard to determine if a depressed state of mind leads to actual increases in pain levels or a heightened sensitivity to existing pain levels.

Effect on Suicide Risks

In the study published in JAMA Psychiatry, federal researchers and researchers from the University of Michigan used a nationwide survey called the National Death Index and Veterans Administration records to assess the connection between pain and the chances of committing suicide in a group of 4,863,086 individuals. Some of these individuals were affected by psychogenic pain, while others had pain stemming from physical conditions such as arthritis, nerve damage, fibromyalgia, back pain, headaches, migraine headaches and tension headaches. The researchers specifically excluded pain related to any form of cancer. The study included both men and women, as well as people from all adult age groups.

When mental illness was not considered as a separate factor, the researchers found that the presence of most types of serious pain increases a person’s risks for committing suicide. The only exceptions to this connection are nerve damage-related pain and arthritis-related pain. When the researchers did consider the effects of mental illness, they concluded that the presence of a diagnosable mental disorder largely accounts for the pain-related suicide risks in most affected individuals.

Considerations

Even when the authors of the study published in JAMA Psychiatry considered the impact of officially diagnosed mental illness, they found that three forms of pain still independently increase the chances for suicide-related death. Those forms of pain are migraine-related pain, back pain and psychogenic pain that doesn’t qualify for a specific mental health diagnosis. The study’s authors believe that their findings point toward a need to identify pain unrelated to a cancer diagnosis as a clear risk factor for suicide. In particular, they emphasize a need to track the suicide risks of people affected by psychogenic pain, migraines or back pain.

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