September is National Suicide Prevention Awareness Month

September is National Suicide Prevention Awareness Month

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

Jenny Picciotto

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,
2 “Risk Factors and Warning Signs.” AFSP, AFSP, 12 June 2018,

3 ibid.
4 Bergland, Christopher. “Chronic Stress Can Damage Brain Structure and Connectivity.” Psychology Today, Sussex Publishers, 12 Feb. 2014,
5 Harkavy-Friedman, Jill. “Policy Brief 11 Understanding Chronic Pain and Suicide .”
6 “Safety Plan.” #BeThe1To, National Suicide Prevention Lifeline,
7 “How The 5 Steps Can Help Someone Who Is Suicidal.” #BeThe1To, National Suicide Prevention Lifeline,
8 Harkavy-Friedman, Jill. “Policy Brief 11 Understanding Chronic Pain and Suicide.”
9 “Take 5 Steps.” Take 5, National Council for Suicide Prevention ,

Authored by: Jenny Picciotto

newest oldest
Notify of
Kathy Pflugrad

So sorry for your loss.
Now when they take away our pain medications. We will be in so much pain that many patients. Might find no other course in life than to commit suicided. My pain has an ugly way of getting me to retreat into myself and away from my loved ones. You need to find a balance of not too many opioids and not enough for the control of pain.
There should be a requirement for opioids. That you see a psychiatrist and medical doctor regularly. And possibly counseling.
The FDA, DEA, and others need to butt out of our way of pain relief. Or many may feel like I do. If they take away our medications. Why not just line us up before a firing squad.
As a Christian I don’t want to think that way but pain is nasty 😫.
PS. Also I would never want to have to turn to street drugs. (You don’t know what you are getting), because of the government banning all opioids

Maureen M.

@Hayden, I am so very sorry for the loss of both your father and your brother, spefically due to the facts of Pain. I can relate… I lost my mother 5 yrs ago at age 77 due to improperly managed and overwhelming pain which put her in bed the last 2 yrs of her life, which brought on severe depression which along with high pain levels caused her to eat very little which caused her stomach muscles to die which the also lead to poor heart and lung function and therefore she died. It was the saddest thing to witness. It all started with poor pain management!
I have Ben in Chronic pain for 25 yrs after a lumbar surgery. 13 yrs later I was in a car accident and had 3 more failed spine surgeries, fusions, hardware etc. I hav never been the same. But, before the witch hunt I too was properly managed but my meds have been lowered and I suffer so much more more. As you know, it is constantly exhausting!
And, I agree 110% with you… Sufficient pain treatment would prevent the rising suicides in our community. This whole issue is so out of control!
Keep strong warrior. Maureen

Maureen M.

Hi Jenny, ger eat to hear from you again. Yours is a wonderful nd very informative writing. Thank you. While informative, I will say though, that most of us cannot find an experienced Pain Management Therapist…I for one have searched in both Connecticut and now here in Fla., let alone getting our insurance to pay for it. Also, a lot of us have little or no ‘in person’ support system. I have 7 siblings…4 who live in the same town as me.
As close as we are in relationships and in distance, they rarely engage to listen to me speak of my Pain and Lupus symptoms and none of them ever come to help me in times of need nor to my rescue. It is truly flabbergasting.
It used to be heart breaking for me, which only added to my pain.
but after working on it, it is just one more thing about life with Chronic illness that I have had to accept. Some people just cannot deal with it, not one spec of it! Most of the CP folks that I personally know only have each other to discuss our conditions with. Yet, we cannot physically help each other. One day at a time…

I hope that you were not effected by the volcano and the recent hurricane in Hawaii. Keep smiling. Aloha, Maureen M.

Dennis Brassaw

As a chronic pain patient I have been to the edge, the place where if you take one step all the pain goes away. However, so does the existence of being.
And life will not come again once you snuff your’s out.
This is a one shot deal, existence in any way, is better than no existence at all, that’s the bottom line.


I too worry what I’ll do if and when my pain meds are reduced or taken away. I can’t go back to a life of constant pain, depression and anxiety. I always thought if that happened I could actually go through with it but I just don’t know. I feel with the government we have now things will get alot worse. All the attention is focused on the ‘addict’ and forget about us pain patients. I will continue to pray for all of us. Please vote these people out of office. Thank-you. God Bless


There is a point where this is a lucidly made, rational decision. My family knows that I will not live my life confined mostly to lying down all day AND back into 24/7 intractable pain. I have very little QOL, but the fact that I have my mom as a caregiver and the fact my doctor hasn’t jumped on the ‘fake prescription pain medication abuse bandwagon’, I have stuck around as I have the high dose opioids required due to my cytochrome 450 defects.

I am prepared to end my life when and if I am back into severe 24/7 pain. I will wait a week or so if my meds are forcibly reduced by insurance or the government and see if the pain level has gone down to manageable. If it hasn’t, then I have a rationally thought out plan!! If you have religious beliefs that say it is not the right answer, then it likely isn’t the right answer. Yet, I must say, I have now heard from friends who had religious reasons NOT to take their lives who have consciously decided that their pain is too much and if not treated, they will take their lives. So, maybe it means you will not know if it is right for you until you are staring at non-stop severe pain 24/7.

The government could have prevented many suicides already and they could prevent many more to come. The newfound, unsubstantiated beliefs in pain meds, being told to legislators and taught to new doctors, needs to be reverted to what the CDC claims was their original intent. That was to remind doctors of going through the proper steps and not jumping straight to opioids. Opioids should be the final choice and patients should be informed of the risks. Together patients and doctors should decide the best course.

The DEA and DOJ needs to stop blaming doctors for those patients that died from overdoses, accidental or intentional. The DOJ and DEA needs to stick to illicit drugs being abused and stay out of the doctor’s offices. Why should any CPP or IPP be left to be tortured to death??!?!

Can the legislators reverse course and treat the addicts separately from CPP patients?


Pain paients want to LIVE. They are being tortured and FORCED to kill themselves by a diabolical forced taper deviced to murder them.


Thank you for the timely article. My guess is 75 % of palliative care pain patients we had have already committed suicide. The forced taper of 1/1/18 will have eliminated the rest of us by next year at this time. How you doctors can standby and do nothing is sinister. You dont want to lose your license or let the genocide and torture continue then please organize yourselves a union. It is too late for most of us but somone needs to stop this insanity.

Susan Simpson

I’m a suicide survivor and lost many to it please also know MANY suicides are not planned, the person snaps! Not all have mental illness. Suicide is very real. Mental illness is equal to physical illness.

Kris Aaron

What this article fails to address is the reason chronic pain patients turn to suicide: uncontrolled pain! The author says “The best way to prevent a crisis from escalating is to plan ahead and decide how you will respond ahead of time.”
How, exactly, do we “plan ahead” for pain breakthroughs when they happen daily? When they literally put us on the floor? When we can’t even cry out because the pain is so overwhelming?
And worse, when we know the stabbing, burning, throbbing torture is coming for us again in a few minutes or an hour?
By taking opiates away from us, the medical community is signing our death warrants. Worse, they know it.
We have two alternatives to pain: One, turn to illegal drugs and risk an overdose with every use. Two, buy a handgun and a box of ammunition, then make a visit to the Smith and Wesson Pain Clinic. In America, handguns are easier to access than illegal drugs, so I guess that’s our answer, right there.
Chronic pain does actual physically noticeable damage to our brains. It’s a common cause of depression that can be easily treated by subduing the pain, which often requires opiates. But politicians have decided that pretty white children of wealthy families who overdosed and died from (supposedly) opiates are a sadder story than the ruined lives of pain patients. Thus, officials have made it nearly impossible for us to find a physician brave enough to write a prescription for the drugs we need.
I don’t blame the doctors. They are being threatened with civil and criminal asset forfeiture laws by the DEA. I DO blame the “drug warriors” who prefer to point fingers at our doctors and Big Pharma manufacturers for the government’s inability to reduce the flood of illegal fentanyl and heroin pouring into the US.
Yes, suicide has begun to look like a viable alternative to a life of agony. And all the well-meaning rhetoric in the world isn’t going to make our pain one bit better. What we NEED is politicians who will listen to us and stop foolish attacks on our doctors. My pain treatment is not the government’s business. I don’t sell my opiates, and I don’t know any pain patients who do. But we’ve lost our prescriptions anyway.
So tell me, exactly how is a lifetime of suffering and pain preferable to a quick, peaceful death?

Caregiver 24/7/365

I have been watching for the data that MUST be compiled regarding suicide rates among chronic pain sufferers, especially (a) those in states where medical marijuana is not legal, and (b) those who have been forced by their doctors to reduce carefully monitored opioids despite the clear feedback that the opioids make their life bearable until a better treatment or med is discovered.

Every day is a challenge to live with someone who is a potential own-life-taker who sees no hope and lives with anxiety about the so-called “opioid crisis” and its impact on seniors and others who are fully informed, carefully monitored by their doctors, and extremely (read: obsessively) cautious about their dosing.

The missing statistic, seems to me, in the discussion of deaths due to opioids is: How many are committing suicide driven by intractable pain that is no longer treated effectively because of arbitrary limitations on legitimately prescribed opioid meds.


As a PMP for over 23 years, I had GREAT success with a dosage of opiate medication used for the last 8 years without an increase in dosage. I know about suicidal tendencies and actual act of cause by actual insufficient management of pain, even when seeking professional help[. The “church” albeit with good intentions to stop or help someone talking about suicide is NOT the place to receive meaningful help to stop a suicidal human being. I lost my Father to suicide for what reason? Unsuccessful pain management when he actively sought until the deed was done… with overpowering continuous pain. I lost my brother about 10 years ago to overdose because of residual pain from surgery in the attempt to correct bodily injuries and residual pain caused from a vehicle accident. I and my family are well versed in pain management, lack of it, overdose from medication and suicide from everlasting continuous pain. I too am a “lifer”. Pain caused by very invasive surgeries on the lower spine. Until the 2016 CDC “guideline” for opiate prescribing doctors, enforced by the DEA I received sufficient opiate medication as the LAST, the very last effective pain management therapy after ALL other therapies, PT, psychiatric “help”, aquatic, you name it, I have tried it to manage pain that is NOT stoppable, only manageable. In my lifetime I have lost my Father to suicide and lifetime, continuous pain related issues and I have lost my younger brother due to pain related issues from an auto accident (not his fault) both relatives lost due to lifetime, severe pain management related issues and MORE likely than not I will lose my life prematurely due to pain management issues that I have dealt with VERY successfully until the “experts” decided that I was receiving “too much” opiate medication that I have records, documentation proving that with in excess of 100 milligrams “of “morphine equivalent” opiate medication I was able to continue to be employed, physically active, socially relative, and to feel as if my life had purpose to remain alive I have experienced both suicide AND overdose in my family due to pain management or the lack of it but, I do not blame opiate medication for either death of my family members. I do not have the answer for lifetime, severe, pain management issues but I do know without a shadow of a doubt what the answer to suicide and overdose is NOT. Reduction in medication which for now, IS the last effective treatment for lifetime pain issues.

Molly Canfield

Just recently reviewed what is in my PM file via patient portal. When I did not see the dianoses that were prsented whicj “allowed” me to be seen as a PM patient (deg disc disease, spondlytis, migraine, 2 spinal fusions, a fractured sternum and 2 fractured vertebrae), I sent a note detailing these to the supervising physician. He replied that he would review my file and see if he could. “Verify these dianoses” and would amend “if appropriate.” So, although his office did not include these dx in my file AND the accompanying “evidence” was provided by me…I’m the one under suspicion and guilty til proven innocent!!!


watch what happens when those prideful, backslapping politicians take everybody’s pain pills away - in their heroic posturing move to “save lives”

I sincerely doubt that pain patients who do commit suicide from lack of decent medication, will be listed as suicide. MANY doctors and families do not want that put on a death certificate.


I think that there will be a huge spike in suicides if the new CDC rule restricting opioids to legit pain patients goes into effect as planned on Jan 1. As someone with acute chronic pain for just shy of a decade, I need my meds. I just started reducing my daily dosage some and have been in agony. I can’t live like this long term, and the new law will make it worse. I know that w/o my meds, I would have killed myself years ago due to horrible pain that never goes away. Even with my meds, I still barely get through a day and have a very poor quality of life. Without them, I wont’ be able to tolerate the endless horrible pain. Not all suicide is irrational.
I have a feeling that after this rule goes into effect, the suicide rate will spike with suicide notes blaming this rule. Then eventually, it will be repealed. But until then, the “opioid epidemic” gets all the attention, and the needs of real patients are ignored.
To make it worse, I firmly believe that this racist gov’t would be acting differently if the opioid abusers were black. Then, like with crack, they’d be jailed and the CDC wouldn’t be doing this. This gov’t is disgusting on every level.

Jenny, thank you so much for putting this information on the national pain report. One of the best friends I ever had took their life in 2011. I still live with the guilt today, if only I would have said this or done that. They told me they had already attempted such and we’re going to again. My cell phone had broken. I had to send it to the company for one week and told my friend to please hang on until I got my phone back, that he would be the first person I called. That if he would just hang on for one week I would help him, we wouldn’t stop until things were okay. I told him to call our church for help, he did and was ignored. I gave him all the cash in my wallet which at the time was $13 to put gas in his car. He ate Easter dinner with us. The day my phone arrived he was the first person I called, his sister answered and told me she had just came in and found him dead, the paramedics were on their way. They estimated he had been gone for three days. Two years later my brother called and told me the same. I live 15 miles from where he was and prayed all the way I wouldn’t get a speeding ticket. I remember grabbing my purse and shoes, that was it. At the time he was in so much pain that he had turned to alcohol, (more heavily than ever.) Often times when someone speaks of suicide people tend to think they’re making it up. That’s a chance no one can take even if they think the person is just wanting attention. Someone who would say this definitely needs attention no matter what. With these two individuals they had no friends, no family, etc. (me being the exception). With chronic pain patients, we all live in a world where we feel isolated more than ever now and very alone. I’ve even read stories on here of those who had talks with their families. I’ll never forget one woman’s story. Her medicine had been so drastically reduced that she had a conversation with her husband and two young boys. If she could not continue to care for them or herself as she had been, that they all would understand, would let her go and honor her wishes. She literally had a shotgun shell with her name written on it. Would you by chance know just how much suicide has increased with chronic pain patients since the opioid crisis began? I think it’s important we all know and that the voices of those who can unfortunately no longer speak be heard. So tragic when one takes their life, so unnecessary when it’s due to our government playing doctor!!