Full Article: http://www.painmedicinenews.com
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
Dr. Fishbain and his colleagues explored the role that feeling like a burden plays in both acute pain patients (APP) and chronic pain patients (CPP) with regard to suicidality (poster 153). Self-perceived burden (SPB) has been linked to depression and suicidality (Pain 2012;153:1735-1741).
The current study looked specifically at pain patients and theorized that SPB rates would be higher among CPPs than the other two groups. It also examined whether those who perceived themselves as a burden would be more likely to be suicidal, positing again that suicidal affirmation would be higher among CPPs.
“The theory behind the study’s burden item was that it should present at greater rates in CPP than the other groups,” said Dr. Fishbain. This proved true, as SPB was found in 102 CPPs (30%), but was also seen in 54 APPs (17%; P=0.00). In both CPP and APP groups, the link to SPB was statistically significant.
The researchers also found SPB occurring at a greater frequency in CPPs who had affirmed suicidality compared with APPs and non-patients who affirmed suicidality. They found that SPB was a significant predictor of all five types of suicidality studied (passive, active, “I’d rather be dead,” suicide plan and suicide attempt).
“The affirmation of burden is a strong predictor of suicidality,” concluded Dr. Fishbain. “You could theoretically ask if they feel like a burden, and that question alone could predict risk for suicidality.”
Dr. Fishbain and the investigators concluded that all CPPs and APPs should be evaluated for suicidality.
Another study focused on the role that acceptance of pain plays in both APPs and CPPs (poster 154).
“Pain acceptance is a big thing in treatment now,” said Dr. Fishbain, MD, Department of Psychiatry, Miami VA Medical Center, and Departments of Psychiatry, Neurologic Surgery and Anesthesiology, University of Miami School of Medicine, defining it as a “behavior pattern with awareness of pain but not directed at changing pain.”
Evidence demonstrates, he said, that patients who accept their pain and do not seek much or any care do better. For example, he said, “they quit going to the doctor a lot, and are more rehabilitation-oriented” (Curr Pain Headache Rep 2006;10:90-94).
Generally speaking, the longer a patient is in pain, the more they come to accept their situation, which to Dr. Fishbain may be key.
“Acceptance could be a function of time,” said Dr. Fishbain. “You can almost boil it down to one item: ‘Do you accept that there is no cure to your pain?’ in terms of whether or not there is suicidality. The longer you’ve accepted that there is no cure, the better you feel.”
APPs and CPPs were compared in terms of how many times they endorsed two items: “little hope of getting better” and “physical problems [pain] can’t be cured.” Patients with chronic pain were statistically significantly more likely than those with acute pain to affirm these two items.
The investigators then theorized that, given its nature, chronic pain would distinguish itself from acute pain (Table). “This was indeed the case,” said Dr. Fishbain. “Chronic pain patients are more likely to accept their pain, acceptance again probably being a function of time. They come to terms with knowing that a cure is unlikely and that there is little hope of getting better; these are all aspects of acceptance.”