The question about the relationship between living with chronic pain and suicide is important to understand. We know that approximately 30 million Americans live with what the U.S. Department of Health and Human Services (HHS) has labeled “high-impact chronic pain,” i.e., pain that is persistent, unrelenting and disabling. In addition, we know that in 2015 approximately 44,000 died by suicide, and some people with chronic pain will die by suicide. The data are scarce and the relationship between these two important public health issues is unclear. This is primarily because both chronic pain and suicide are complex, involving biological, psychological, social and environmental factors. With people living longer, there will be more people living with chronic pain and most likely more people dying by suicide in the years to come. By gaining familiarity with both suicide and chronic pain, the nature of their relationship becomes clearer.

Scope of the Problem
In 2015, the rate of suicide was 13/100,000. It is estimated that the rate of suicide among people with chronic pain is 23/100,000 or approximately double the rate of suicide in the general population, though still infrequent. Suicidal ideation, suicide attempts and death by suicide are not equivalent in that many more people think about suicide than attempt suicide and even fewer people die by suicide. While suicidal ideation and suicide attempts are considered strong predictors of suicide, less than 10 percent of those who have made a suicide attempt go on to die by suicide. Unfortunately, about 60 percent of those who die by suicide have no previous attempt and used lethal means for their first attempt. This is one reason that understanding the risk factors and learning the warning signs of suicide, as well as limiting access to lethal means when someone is at risk, are so important.

We are pleased to announce the release of Understanding Chronic Pain and Suicide, which is the eleventh in a series of briefs profiling policy and educational issues important to improving chronic pain. We wish to thank contributor: Jill Harkavy-Friedman, PhD, Vice President of Research, American Foundation for Suicide Prevention and editors: Richard Payne, MD, John B. Francis Chair, Center for Practical Bioethics, Bob Twillman, PhD, FAPM, Executive Director, Academy of Integrative Pain Management and James Cleary, MD, FAChPM, Associate Professor of Medicine University of Wisconsin and Director of the Pain and Policy Studies Group.

This policy and educational brief is a product of the Pain Action Alliance to Implement a National Strategy (PAINS) and the Center for Practical Bioethics.

The Policy & Educational Brief Series is designed as a tool for PAINS members to support their work to improve pain policy. In the spirit of the alliance, the Brief is designed as an “open document” so any member organization or individual can brand it with their name and contact information. The back page of the brief is designed with a space marked “This copy is made available to you by:” for easy personalization.

Everyone can download a master electronic copy. Hard copies of the latest issue can be ordered in a package of 10 or 20 for free and there is a flat rate mailing cost of $5.00. If you want larger quantities, please contact us.

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