Chronic Pain and Suicide Risk (Or why aren't we addressing such the need for help in such a high risk group?)

I recently had a doc say to me "Fibromyalgia won't kill you."

I know this. I've dealt with this condition most of my life.

I shot back, "Yeah, I know. The other half of that statement is 'But it will make you wish you were dead.'."

Let's just say that particular doctor's visit didn't go well.

The reality is that there are many chronic pain conditions and illnesses that in themselves, are not deadly. That part is true. But the damage that these conditions cause to our lives, livelihoods, bodies, relationships, and even our daily interactions can and do place individuals with chronic pain and chronic illness at a higher risk for suicidality.

A recent article published by the American Chronic Pain Association (2016) reports that a recent survey they conducted showed that 47% of the respondents (chronic pain patients) have contemplated suicide. Given that 100 million Americans are living with chronic pain (according to the National Institute of Health), one would think that there would be more attention given to what is such a high risk group and such a large part of the population.

And frankly--even more concerning--is that the recent push from the CDC and other federal entities to limit the access of opiate pain medication has had an increasing negative impact on suicide rates. In short, since chronic pain warriors are having more difficult accessing the medication they need to control their pain, the suicide rate among this population is rising (Pain News Network, 2016).

Why are Chronic Pain Warriors at higher risk for Depression/Anxiety?

There are a number of factors that can contribute to depression and anxiety, including not enough sleep (or enough restful sleep), isolation, not getting enough Vitamin D, some health conditions, a chemical predisposition to mental health challenges, and many others.  For instance, if someone with Fibromyalgia has sleep disturbances, this is not only going to cause an increase in the level of pain, but it's likely to impact the person's ability to interact with the outside world (leading to increased isolation), and may start a cycle of poor sleep due to pain leading to more poor sleep and so on.

And then, there is the stigma. This comes from everywhere. It's in the judgement of every person who watches me get out of the car when I have to use an accessible space to the coworkers who wonder why I called in sick to the doctors who tell me I shouldn't feel this bad (when they themselves can't begin to fathom what I feel). It's from well meaning but misdirected individuals who offer the "cure" their brother's second wife's cousin is selling this week for all conditions. Maybe we have family and friends that we feel we're asking too much of or have become a burden to.The stigma is isolating as well.

And, of course, there is stigma in reaching out for help with mental health. There are the lack of resources for individuals reaching out for mental health. In addition, while there is an increasing understanding of the impact of chronic pain and illness on mental health, this is still a growing movement, so the professionals who are competent in chronic pain tend to be scarce.

How do we address this?

The good news is that there is a growing trend (Thanks Medicare!) to have patients of all backgrounds complete a Patient Health Questionnaire (PHQ) when they see their PCP. The PHQ is a screening tool for depression, and it also screens for suicidality. This can be a very useful tool, and since Medicare implemented requirements for screening tools to be utilized as a part of patient care, other insurance companies are noticing and following suit.

Social media has also been a great place for chronic pain warriors to find support from fellow chronic pain warriors, and some areas have in-person support groups. These can be great resources.

Ultimately, though, care for people like me has to be holistic and address my mental health needs as well as my physical health needs. This means all of the systems of the healthcare system need to come together to treat Chronic Pain Warriors as the whole person that they are (chronic pain and all). It requires an approach that is common sense in many ways, but is rarely put into practice: treat the whole person, not just the problem area.

And finally, medicine and the CDC need to realize that there is an appropriate place for opiate pain medications in chronic pain management. It's not necessarily the whole treatment plan, but it can be part of a comprehensive treatment plan, and for many people, it's a necessary part of treatment. It may be the only thing keeping someone going on with the fight against their pain.

If you or someone you know are experiencing suicidal thoughts, get help. The National Suicide Prevention Lifeline can be reached by calling 1-800-273-8255 or visit their site for live chat.

Mental Health and Chronic Pain (or No matter how much you try, you can't separate one from the other.)

Mental illness is still a somewhat taboo subject, despite the fact that 1 in 5 Americans experiences mental illness in a given year and 1 in 20 experiences a serious mental illness (one that substantially limits the ability to function in life.)  For more information on these statistics, check out the National Alliance on Mental Illness. 

Individuals dealing with chronic pain/invisible illness are at a higher risk of being depressed/anxious, and yet it's the double whammy of stigma.  Furthermore, so much of medicine still wants to separate the "physical illness" from the "mental illness".  We're a whole person, and yet our treatment is silo-ed.  And this doesn't work in the long run.  

And those living with chronic pain/invisible illness frequently get "accused" of being depressed.  My response to that?

Of course I am. I have to live in a body where my mind is sharp and wants to do all sorts of things, but my body says "Nope." I don't sleep, so my body never gets a chance to heal, and I never get a chance to get all those good benefits of sleep, so yes, my mood is poor. My disease keeps me isolated at times.  

While Lupus/RA can be fatal because of what kind of damage they can do the body, Fibromyalgia is not.  And yet, there is a number one cause of death to those individuals who are diagnosed with Fibromyalgia:  suicide.

So, how do we keep someone from being a statistic?  First, we need to realize that a person experiencing chronic pain/invisible illness is a whole person.  Yes, they have pain, but there is so much more than just pain.  That pain is affecting how they live their life.  That pain could be impacting their loved ones around them.  

To start, a disclosure:  I'm a therapist, so I'm pretty big on the whole "everyone can benefit from counseling in some way" thing.  I've worked with couples, families, and individuals of all age groups, from those individuals who just needed a little extra assistance to the Seriously and Persistently Mentally Ill.  My "go-to" modality tends to be Brief Solution Focused Therapy with a little Cognitive Behavioral Therapy thrown in, but I'm also trained in some other modalities and have experience in working to help address trauma.  

That said, I truly believe that anyone diagnosed with chronic pain/invisible illness can benefit from some mental health support.  Therapists can assist in processing the trauma of being diagnosed and living with chronic illness, can assist in being a sounding board for processing thoughts and feelings, can teach coping and relaxation skills, can provide couples and family counseling, and can just generally be one more person in your corner for support.

But not all therapists are going to be right for all people or all conditions. Just like finding a primary care doctor or specialist who will work with you, it can be a process to find a therapist that fits with you, so here are some helpful hints:

• Define your preferences for a practitioner.  Would you rather work with a male or female (or is this not an issue for you)?  Where would you like to receive your services (office?  maybe via phone?  online?)  Some of this will likely be limited by insurance or your ability to pay out of pocket, but insurance companies are required to provide the same level of coverage for mental health as they as physical healthcare.  
• Ask questions of the potential therapist.  What is their background?  In what are they experienced?  Are they familiar with the condition you're dealing with (or are they willing to learn about the condition)?  
• Just a side note here.  Do not be concerned if the therapist starts asking you questions about your condition or your experience with the condition after indication that they're familiar with it.  Everyone experiences things differently and what could be a very problematic experience to one person may not be that problematic for another.  Even if I have another chronic pain warrior sitting across from me as a client, I will still ask them what they are experiencing, how that experience is for them, and what they hope to gain from counseling. That's how client centered therapy works--we start where the client is at that moment and move from there.
• Define why you are seeking mental health treatment.  Are you looking for ways to cope or manage pain better (without additional medication intervention)? Are you looking for ways to process your feelings about your condition?  Are you looking for couples counseling so that you and your spouse can receive help around this issue? Defining what you hope to gain will help you find an appropriate therapist who utilizes an appropriate type of treatment to assist you.
• Educate yourself on different treatment modalities. There are probably hundreds, if not thousands of different types of treatment modalities that exist. Some, like Brief Solution Focused Therapy, is more of a problem solving intervention that is very short term.  Cognitive Behavioral Therapy can also be short term, and it focuses on changing thoughts and behavior.  There are some specialty treatment out there that focuses on trauma (and some are said to be beneficial for pain management), such as Eye Movement Desensitization and Reprocessing Therapy (EMDR).  There are even treatments that utilize art therapy and art therapy techniques.  Not everyone is going to be comfortable receiving all types of therapeutic treatments, and if you're not comfortable with it, it's not going to work for you.
• Understand that therapy is work.  Frankly, if you're not willing to do the work, no therapist or modality out there will likely work for you.  But the work should be balanced.
• Be open and honest with your therapist. They can only help you if they have all of the information. In addition, if something they suggest feels like something you aren't going to do, tell them. They're working to help you, and so giving lip service to something only hurts yourself in the long run.

If you or someone you love is experiencing suicidal thoughts, please ask for help.  The National Suicide Prevention Lifeline can be reached at (800) 273-8255.  

For those interested in online therapy with me, my online office can be accessed here.

Definitions of conditions listed in my medical chart.