ALERT: Pain and Suicide Attempts in the Hospital or Emergency Setting

The holidays bring with it the added risk of suicide attempts for an increased number of people.  Suicide deaths rise during the holiday season, and this is a fact of which we may all be aware, but tend not to recognize until an attempt is made by someone we care about.

It's widely recognized that suicide is a risk for depressed and psychiatric patients.  What is not recognized and probably highly under-reported is that it is a serious risk for severe and chronic pain patients, outside of a psychiatric diagnosis or setting.

An article in US Department of Health and Human Services mentions a Joint Commission alert telling doctors that it is not just psychiatric patients that commit suicide in the hospital setting, but those in pain as well.  The article states that of 827 (voluntarily reported) in-hospital suicides, a large number - 25% of them - were in non-psychiatric settings.

Making these non-psychiatric patients different are their presenting complaints and diagnosis.  The medical team concentrates on the physical aspects they can control - fever, hydration, etc - and miss important assessment of the patient's mental and emotional symptoms related to their distress.

Living with daily pain is a physical and mental battle. Patients with chronic pain can become exhausted, and feelings of hopelessness which begets desperation, begin to pervade.  If the pain becomes too severe, or if the patient sees no end to their pain, they often feel that life is unbearable because their past experience has taught them this fact.



Photo copyright 2008 Ellen Schnakenberg: starving horse 

They are trapped, and escape from pain becomes the focus of their thoughts, yet they may not talk about it.  If their pain remains undertreated - or they are denied the medication they need - they are at significant risk for suicide.  If their pain is severe enough, or their desperation is profound, these patients may not wait until they get home to attempt suicide.

The article also discusses the specific symptoms and signs someone in chronic pain may come to the hospital complaining of: "irritability, agitation, complaints of unrelenting pain, refusing visitors or medications and requesting early discharge, the commission noted. Dementia, chronic pain or illness, end-stage cancer, acute signs of depression and drug or alcohol intoxication may also heighten suicide risk."

Desperate people will find a way to do desperate things.

Caretakers, friends and family members of chronic pain patients need to be aware of the above signs and symptoms so they can alert doctors and remind them that they have reason to worry about their loved one.  Protect them by being sure your loved one is getting the pain relief and care that is needed.  Understand that pain DOES kill. Don't be afraid to seek a second opinion, or third or fourth if that's what's necessary.  These patients are not drug seeking addicts.  They are seeking relief from their tormentor - their pain.  If they are denied relief from this tormentor, many will find their own ways, leaving friends and family to pick up what they have left behind them...