| One-Minute Clinician

Suicidal Thoughts: A Potentially Deadly Side Effect

I think suicide is a silent epidemic. I think we’ve been so obsessed with the “opioid crisis” that we really miss this cry for help from patients with chronic musculoskeletal or nonmalignant pain and malignant pain. Almost 50% of patients with chronic pain have suicidal thoughts, and they may not act on it, but one study showed that if you had chronic pain, you were 50% more likely to end your life by suicide. If you didn’t include “pain in the general population” in the study, the figures are even more staggering for people who have substance use disorders. If someone has an alcohol use disorder, they’re 10 times more likely than the general population to end their life by suicide. If they have an injection use disorder, they’re 14 times more likely to end their life by suicide. Patients who have chronic pain and an opioid use disorder are particularly vulnerable to self-harm. I think we’re so focused on opiates and the “opiates are good, opiates are bad” debate and political debate that again we just sort of don’t see this cry for help. I’d really try to tell practitioners that when patients have chronic pain, they typically have comorbidities and depression, anxiety, sleep disturbance, all of which increases the risk for suicidal ideation. Aggressively treating these comorbidities is going to do two things: One, patients are going to opioid-spare because we know that when people get restorative sleep, it actually improves their pain tolerance, also decreases inflammation in their body, and also improves their mood. If we aggressively treat their depression or anxiety, then we’re going to start to see a decrease in the opioid demands, and also going to mitigate the risk of suicide.