Tuesday, January 5, 2016

Chronic Pain

Guest Blog by Holly Gilliam
Non-malignant chronic pain is a national pandemic, affecting 20% of all adults who seek primary care treatment (Tang, 2006).  Chronic pain is associated with “poorer physical health, lower quality of life and a higher risk of developing major depression,” (Tang, 2006). Indeed, people with chronic pain are also at a higher risk to die by suicide (Illgen et al., 2010). Given the prevalence of chronic pain in today’s society and its association with suicide, it is important for clinicians and the general public to learn more about it.
Holly Gilliam
Aversion to pain evolved as a means of self-preservation, but there are times when it is maladaptive. With chronic pain, the difference between taking a medication as medically needed as opposed using a medication as a crutch is important for clinicians and caretakers to differentiate. Research demonstrates that 75% of people who have chronic pain and suicidal ideation, reported that they planned to die via drug overdose (Smith, 2014). Clinicians or caretakers can reduce the likelihood of a person dying by suicide by reducing their access to lethal means (Joiner et al., 2009). One way a family member can reduce access to lethal means is by administering medications to person with chronic pain, as opposed to letting them be in charge of their own pain management. (Cheattle, 2011). This prevents the chance of the person attempting to overdose on their medication.
One thing that can increase a person’s risk of suicidality is whether or not the person has become disabled and/ or unemployed due to their pain. These people were six times more likely to report suicidal ideation (Racine, Choinière, & Nelson, 2014). One reason for this may be the sense of loss elicited by the change in status. While interviewing Dr. Storaasli about his experience in working with clients who have chronic pain, and in working through his own chronic pain, he explained that there is often a sense of loss that people who have chronic pain struggle with (R. Storassli, personal communication, August 5, 2015). This loss can include things such as a change in identity, financial status, independence, etc.
The social network of a person with chronic pain is a valuable asset for helping them. People with chronic pain can be isolated from the people around them due to how painful movement itself can be. Physical isolation can, in turn, translate to emotional isolation thereby increasing risk of suicidal ideation. Identifying people in the person’s life whom they feel comfortable talking to in times of emotional distress can aid in reducing feelings of isolation (Chesin, 2013). If the person is unable to identify people whom they feel would help reduce their stress, they can also seek out the guidance of other people who have attempted suicide. www.suicidology.org has a list of support groups and other resources for suicide attempt survivors.
Holly Gilliam earned a M.A. in clinical psychology at the University of Denver. She is currently enrolled in the University of Denver’s doctoral program for clinical psychology. Fun facts: she enjoys doing yoga and eating delicious food.
Cheatle, M. D. (2011). Depression, chronic pain, and suicide by overdose: On the edge. Pain Med, 12(2), 43.
Chesin, M. (2013). Risk assessment and psychosocial interventions for suicidal patients. Bipolar Disorders, 15(5), 584.
Illgen, M. A., Zivin, K., Austin, K. L., Bohnert, A. S., Czyz, E. L., Valenstein, M., & Kilbourne, A. M. (2010). Severe pain predicts greater likelihood of subsequent suicide [Abstract]. Suicide & Life-Threatening Behavior, 40(6) 597.
Joiner, J. E., Van Orden, K. A., Witte, T. K., & Rudd, M. D. (2009). The interpersonal theory of suicide: Guidance for working with suicial clients. Washington D.C.: American Psychological Association.
Racine, M., Choinière, M., & Nielson, W. R. (2014). Predictors of suicidal ideation in chronic pain patients: An exploratory study [Abstract]. The Clinical Journal of Pain, 30(5) 371.
Smith, M. T. (2004). Suicidal ideation, plans, and attempts in chronic pain patients: Factors associated with increased risk. Pain (Amsterdam), 111(1-2), 201.
Tang, N. K. Y. (2006). Suicidality in chronic pain: A review of the prevalence, risk factors and psychological links. Psychological Medicine, 36(5), 575.