Pain Science Education Episode 257 | Suicide Prevention And Chronic Pain With Joan Rosenberg, PhD
We have an important episode. We're discussing the association between chronic pain and suicide. The information you'll learn in this episode may help you screen for the risk of suicide more effectively. It may help you effectively treat suicide, and by learning and sharing this information, you may save a life. According to the American Foundation for Suicide Prevention, suicide is the tenth leading cause of death in the United States.
In 2019, approximately 48,000 Americans died by suicide. In that same year, there were an estimated 1.4 million suicide attempts. Chronic pain is a risk factor for suicide, and research indicates that chronic pain is present in about 10% of those who die by suicide. It's important as licensed healthcare professionals and loved ones of those who live with chronic pain that we learn how to ask the right questions, assess for risk factors, and intervene to help prevent suicide rates.
In a few moments, you'll meet Clinical Psychologist, Dr. Joan Rosenberg, who has conducted research in the field of suicide, as well as treated patients in her clinical practice. Before we begin, I wanted to provide you with some information to effectively ask, assess, and intervene in those you feel may be at risk for suicide, especially those who live with chronic pain. First, I'd like to provide you with a shortlist of factors that may increase the risk of suicidal behavior among people living with chronic pain.
If you're a healthcare professional, these might surprise you because we see common risk factors almost every day when we treat people with chronic pain. The first one is insomnia. Insomnia is common among people living with pain and also associated with an increased risk of suicide. The next is an over-reliance on passive coping strategies when you recognize or observe that someone is hoping their pain will go away from these passive coping strategies, increasing their risk of suicide.
The next is pain catastrophizing, a topic we've talked about in-depth on this show. All of us are well aware of the catastrophizing pain scale, and there are also other scales and self-report measures that identify catastrophizing. It's very important that we include that in our initial paperwork. The next is prescription pain medication access when other factors are present.
We're talking mostly about opioids here. It's not just if someone is taking opioids. There have to be several other factors. The factors that you learned about now present. As we're talking about prescription medication, always be on the lookout for what they call the triple threat, which is opioid, anti-anxiety medication, and alcohol use disorders. Those three together, people oftentimes overdose as well as an increased risk factor for suicidality.
There are specific pain diagnoses that have been associated with an increased risk, specifically chronic lower back pain. The diagnosis of psychogenic pain, which is medically unexplained pain or medically explained physical symptoms as well as migraine, those three, chronic lower back pain, psychogenic pain, and migraines.
Feelings of helplessness or hopelessness, individuals who will feel that they can do nothing to change or impact their pain and believe that positive outcomes are not possible for them may be at an increased risk for suicide, and then finally isolation or perceived burdensomeness. Oftentimes these go together. If you recognize or identify distressed and interpersonal relationships where someone feels like they are a burden to others or express feelings of not belonging, these are associated with an increased risk of suicide.
Suicide can look and sound a lot like depression. It's important that we screen for depression. We all know that depression rates are high in those living with pain. There's a simple way that you can screen for depression in your clinical practice, no matter what type of health professional you are. That's with the PHQ-9, Patient Health Questionnaire-9. It's readily available online if you google Patient Health Questionnaire-9.
This is a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression. It includes nine questions. What's great about this is not only does it screen for depression but question number nine is a single screening question on suicide risk. A patient who answers yes to question nine needs further assessment for suicide risk by an individual who is competent to assess this risk that may or may not be you. Hopefully, by the end of this episode, you will realize that screening for suicide is possible.
What I also like about the PHQ-9 is it gives you a couple of different cutoff points for mild, moderate, moderately severe, and severe depression. With those cutoff points, it recommends proposed treatment action for each cutoff point. It's Patient Health Questionnaire-9, super simple, nine questions to screen for depression. Question number nine is specifically for suicide risk.
With some of that background information, let's bring in our expert guest, Dr. Joan Rosenberg. Dr. Rosenberg is a cutting-edge psychologist known globally as an innovator in the field of mental health. She is a two-time TEDx speaker and serves as a blogger for Psychology Today and has been a featured expert in multiple documentaries on television and radio.
As a licensed psychologist, Dr. Rosenberg speaks on how to build emotional strength and resilience, psychotherapy, and suicide prevention. She's a Professor of Psychology at Pepperdine University in Los Angeles, California, as well as maintains an active clinical practice. This episode aims to create a roadmap or a blueprint for assessing and intervening with suicide. Without further ado, let's begin and learn about this important topic and meet Dr. Joan Rosenberg.
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