By Jenny Picciotto.
The Academy of Integrated Pain Management reports that “the rate of suicide among people with chronic pain is approximately double the rate of suicide in the general population.” However, they state that “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.”1
People living with chronic pain face many of the risk factors and warning signs associated with suicide, including dealing with a serious health disorder, managing depression and/or anxiety, experiencing prolonged stress, social isolation, feeling like a burden, fatigue, and more.2 These biological, psychological, and social conditions are often beyond our control.
According to the American Foundation for Suicide Prevention: “Suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and despair. Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Conditions like depression, anxiety and substance problems, especially when unaddressed, increase risk for suicide. Yet it’s important to note that most people who actively manage their mental health conditions go on to engage in life.3
Suffering affects us physically, mentally, and emotionally, but our health care providers often focus on physical symptoms, overlooking signs of depression. Some people resist addressing the mental health aspects of living with chronic pain because they worry they will be told their pain is “all in their head.” But serious physical health problems are often accompanied by complex emotional responses. To further complicate matters, exposure to prolonged stress causes physiologic changes to the brain that perpetuates stress and affects mood, including anxiety, depression, and PTSD.4 While it may be impossible to eliminate the stress of living with chronic pain, there are steps you can take to reduce their effects. Ninety percent of people who die by suicide are experiencing a diagnosable and potentially treatable mental health condition.5
Developing a personal toolkit for living with chronic pain can help restore a sense of control and strengthen resilience. This includes pain management strategies, relaxation and stress reduction skills, engaging in activities that are meaningful, and practicing self acceptance. We also need a good support system of people we can rely on such as family, friends, support groups, therapists or counselors with whom we feel comfortable talking about how we really feel. Working with a skilled pain management therapist can help us learn new coping skills and provide a safe space for exploring and processing feelings. But sometimes we may be faced with overwhelming circumstances, a health or emotional crisis.
The best way to prevent a crisis from escalating is to plan ahead and decide how you will respond ahead of time. A safety plan, often composed with the help of a counselor, is a step by step process that begins with identifying certain situations, thoughts or feelings that you recognize as the warning signs of a potential crisis. This self awareness gives you time to intervene. The action steps include identifying coping strategies, developing social support systems, resources you can contact for professional help, and ensuring you are in a safe environment.
BeThe1To is a resource of the National Suicide Prevention Lifeline. Their website contains information about creating a safety plan6 , and has developed The Five Steps7 , guidance on how you can help someone in distress.
The first step is to ask. “Asking someone about suicide will not make them suicidal, and not asking may lead to a missed opportunity to help a suicidal person access resources and strategies for reducing their suicide risk.” 8 Having a nonjudgmental caring discussion includes asking how you can help, and listening. The majority of people who have thought about suicide do not go on to kill themselves. By connecting and expressing concern for someone in distress you show you care and that they are not alone. Find out if they are in any immediate danger, and stay with them, either on the phone or in person until you can connect them with support - either their own mental health counselor, or with a service like the National Suicide Prevention Lifeline (1-800-273-8255). The last step is to follow up. Reaching out can increase feelings of connectedness and reduce the risk of suicide.
We can all help prevent suicide. If you or someone you know is having trouble coping, taking steps to learn coping skills and talking about mental health can make a difference. If we
recognize the warning signs, we can take proactive steps to save a life.
The National Council for Suicide Prevention’s “Take 5 to Save Lives”9 website has more information about how you can take 5 minutes to take 5 actions in support of National Suicide Prevention Awareness.
If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.
Jenny Picciotto is a writer and CRPS patient who enjoys reading and playing the piano. She was a yoga instructor and massage therapist before CRPS changed her trajectory. She currently lives in Hawaii, where she facilitates the Oahu CRPS Support Group.
1 Harkavy-Friedman, Jill. “Policy Brief 11 Understanding Chronic Pain and Suicide .” Edited by Cindy Leyland, Academy of Integrative Pain Management PAINS Project, Academy of Integrative Pain Management, Dec. 2017, painsproject.org/aipm/wp-content/uploads/2017/12/Policy_Brief_11_Chronic_Pain_and_Suicide_web.pdf.
2 “Risk Factors and Warning Signs.” AFSP, AFSP, 12 June 2018, afsp.org/about-suicide/risk-factors-and-warning-signs/.
4 Bergland, Christopher. “Chronic Stress Can Damage Brain Structure and Connectivity.” Psychology Today, Sussex Publishers, 12 Feb. 2014, www.psychologytoday.com/us/blog/the-athletes-way/201402/chronic-stress-can-damage-brain-structure-and-connectivity.
5 Harkavy-Friedman, Jill. “Policy Brief 11 Understanding Chronic Pain and Suicide .”
6 “Safety Plan.” #BeThe1To, National Suicide Prevention Lifeline, www.bethe1to.com/safety-plan/.
7 “How The 5 Steps Can Help Someone Who Is Suicidal.” #BeThe1To, National Suicide Prevention Lifeline, www.bethe1to.com/bethe1to-steps-evidence/.
8 Harkavy-Friedman, Jill. “Policy Brief 11 Understanding Chronic Pain and Suicide.”
9 “Take 5 Steps.” Take 5, National Council for Suicide Prevention , www.take5tosavelives.org/take-5-steps.