Chronic pain and suicide: understanding the association.

Chronic pain conditions are associated with an elevated risk for suicide. Of particular importance is the question of why pain conditions might be linked to increased suicide risk. We discuss the association between chronic pain and psychological pain, particularly in the context of depression, and the use of suicide as an attempt to escape from what is perceived as unbearable suffering. We also consider the role that chronic pain may play in increasing the capacity for suicide. Bridging across research areas and drawing on the interpersonal-psychological theory of suicide, we suggest that chronic pain may facilitate the development of a key risk factor for suicide: fearlessness about death. Given that chronic pain can lead to (and be exacerbated by) depression, engender hopelessness, facilitate a desire for escape through death, and erode the natural fear of dying, clinicians must be aware of psychological processes that can combine to create elevated suicide risk in patients with chronic pain, and they should also assess and treat suicide risk factors in these patients.