Tale of Two Suicides; Lessons for Opioid Public Policy


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Tale of Two Suicides; Lessons for Opioid Public Policy

For one it was the best of times, for the other, the worst. At no time did the paths of their lives cross, but they shared the same fate, one most would consider a tragedy. Their legacies, for pain and public policy, could not have been more different…
I knew one, only heard of the other; both dramatically affected my life.

Bob was a marine. He had valiantly served his country, and he was proud of it. His identity was so tied to his service that he could not handle the thought of being any less of a marine, a warrior… a man, whatever that means. His back injury robbed him of that identity, and he struggled in a futile attempt to regain that which he no longer was, or, at least thought he was. Perception is reality, and his perception was that he was no longer what he wanted to be, needed to be.

Surgeries and elixers, therapies traditional and non-traditional. All tried in a vain attempt to rid himself his pain. All failed. Some made his pain worse. He used pain meds to numb the pain, but they couldn’t restore his manhood. In desperation, he kept taking more and more. After a while, he gave up the hope for a cure. He was a broken man, not just physically, but also mentally and spiritually. The meds became a temporary reprieve from his painful reality. I was his doctor. I never really saw that brave marine. Rather, I saw a broken, staggering man, subservient to the world his pain had created for him. Our goal for any treatment is to improve one’s function. For many, opioids accomplish that. Not for Bob.

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Antiepileptic Drugs Increase Suicide Risk


Antiepileptic Drugs Increase Suicide Risk

Drug regulators are warning clinicians that patients who take drugs to control epileptic seizures or to treat other conditions, such as chronic pain, may be at increased risk for suicide.
The FDA alert, issued in late January, covers all commonly used antiepileptic drugs. The agency said it will begin requiring makers of the medications to include the risk for suicide on the products’ labeling. The FDA acknowledged that no cause-and-effect relationship has been established between suicide and antiepileptic drugs and did not advise physicians to stop prescribing these medications (Table 1).
Table 1. Antiepileptic Drugs Associated With Suicide
Carbamazepine
Felbamate (Felbatol, MedPointe Pharmaceuticals)
Gabapentin
Lamotrigine
Levetiracetam (Keppra, UCB Pharma)
Oxcarbazepine (Trileptal, Novartis)
Pregabalin (Lyrica, Pfizer)
Tiagabine (Gabitril, Cephalon)
Topiramate
Valproate
Zonisamide

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Type of Chronic Pain May Affect Risk for Suicide


Type of Chronic Pain May Affect Risk for Suicide

Suicide is the 10th most common cause of death in the United States, and is often related to serious depression, alcohol or substance abuse, or a major stressful event. Given the high correlation between chronic illness and depression, it is not surprising that studies have found suicidal ideation, suicide attempts and suicide completions to be common in patients with chronic noncancer pain. Now, researchers believe that the type of chronic pain also may play a role in risk for suicide.
“About 20% [of patients with chronic pain] most likely have passing suicidal thoughts; 5% have active thoughts; and about 5% have a past history,” said Martin Cheatle, PhD, director of the Pain and Chemical Dependency Program at the University of Pennsylvania, Philadelphia. “So, it is a pretty significant problem.”
Recent research has now expanded its scope to determine what chronic pain conditions are most closely linked to suicide risk. A study conducted in Spain found that suicidal ideation is highly prevalent among patients with severe fibromyalgia, a disorder that is characterized by chronic pain, sleep disturbances and depression (Pain Pract 2014 Jan 17. [Epub ahead of print]). Of 373 patients with fibromyalgia, 179 (48%) reported suicidal ideation. Of those, 148 (39.7%) described what was considered to be passive suicidal ideation and 31 (8.3%) reported active suicidal ideation. Risk for suicide was more commonly related to symptoms of psychological distress (depression, anxiety, sleep quality, mental health) than to physical symptoms of the disease (pain, general health).

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People who experience acute or chronic pain are at increased risk for thinking about killing someone else and then killing themselves, according to a new study


People who experience acute or chronic pain are at increased risk for thinking about killing someone else and then killing themselves, according to a new study.

Previous research has found that pain patients are at increased risk for suicide, most likely because they’re more prone to depression. The current study is the first to link pain with thoughts of homicide–suicide.
“We found that about 4.4% of patients in rehabilitation for chronic pain had some ideation about homicide–suicide,” said co-author Daniel Bruns, PsyD, a psychologist practicing in Greeley, Colo. This was more than twice as many as in the control group.
The study, which was presented as a poster at the 2010 annual scientific meeting of the American Pain Society in Baltimore (Poster 144), included 2,264 people at 106 sites across the United States. Participants filled out the Battery for Health Improvement 2 (BHI 2) questionnaire and were asked to respond to a number of statements about suicide and violence, including, “If I was going to kill myself, I would take somebody else with me.”

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Suicide and Pain: Research Explores Links to Suffering, Acceptance, Burden


Suicide and Pain: Research Explores Links to Suffering, Acceptance, Burden

NATIONAL HARBOR, MD—Walking among his three clinical research posters at the recent annual meeting of the American Academy of Pain Medicine, pain expert David Fishbain, MD, stopped in his tracks and stated the obvious.
“As you can probably tell,” the Pain Medicine News editorial advisory board member said while waving at the three pieces of research he was involved in, “we are pretty interested in suicidality.”
That interest has spawned a series of studies on various psychological aspects of suicidality in pain patients from Dr. Fishbain and his colleagues from Florida’s University of Miami School of Medicine. The three works explore questions surrounding the effects of burden, acceptance and suffering on both pain and suicidality. The studies, presented in poster form at the AAPM meeting, also touch on specific predictors and screening strategies to assess for suicidality in a pain population.
The Burden of Burden

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Suicide and Pain: Research Explores Links to Suffering, Acceptance, Burden


Suicide and Pain: Research Explores Links to Suffering, Acceptance, Burden

NATIONAL HARBOR, MD—Walking among his three clinical research posters at the recent annual meeting of the American Academy of Pain Medicine, pain expert David Fishbain, MD, stopped in his tracks and stated the obvious.
“As you can probably tell,” the Pain Medicine News editorial advisory board member said while waving at the three pieces of research he was involved in, “we are pretty interested in suicidality.”
That interest has spawned a series of studies on various psychological aspects of suicidality in pain patients from Dr. Fishbain and his colleagues from Florida’s University of Miami School of Medicine. The three works explore questions surrounding the effects of burden, acceptance and suffering on both pain and suicidality. The studies, presented in poster form at the AAPM meeting, also touch on specific predictors and screening strategies to assess for suicidality in a pain population.
The Burden of Burden

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http://www.chronicintractablepainandyou.net/apps/forums/topics/show/13183745-suicide-and-pain-research-explores-links-to-suffering-acceptance-burden?next=

Another Study Links Chronic Pain and Suicide


Another Study Links Chronic Pain and Suicide

Suicide is the 10th most common cause of death in the United States and a growing body of scientific literature suggests that chronic pain is associated with suicidal ideation, attempts, and mortality. However, there have been limited data on the extent to which specific pain conditions might be linked to suicides. New research suggests that back pain, migraine, and psychogenic pain may be of greatest concern.

In this new study, Mark A. Ilgen, PhD — of the U.S. Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan — and colleagues examined associations between clinical diagnoses of chronic noncancer pain conditions and suicide in a very large population of patients served by the VA Healthcare System (Ilgen et al. 2013). The researchers retrospectively identified 4,863,036 individuals who received services in fiscal year 2005 and were alive at the start of fiscal year 2006.

During a 3-year followup period (spanning fiscal years 2006-2008), there were 2,838 suicides in patients with pain conditions. The data were examined for associations between baseline clinical diagnoses of arthritis, back pain, migraine, neuropathy, headache or tension headache, fibromyalgia, and psychogenic pain and subsequent suicide death recorded in the National Death Index. At baseline, 92% of the patients were male and the vast majority (81%) were aged 50 years or older — more than a third (38%) were older than 70 years of age.

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