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Patients with chronic pain are at higher risk for suicide. Patients who are tapering opioids are at even higher risk of suicide.

Risk factors for suicide among patients with chronic pain include the following:

Factors that may increase a person’s risk for suicide include:

  • Current ideation, intent, plan, access to means
  • Previous suicide attempt or attempts
  • Alcohol / Substance abuse
  • Current or previous history of psychiatric diagnosis
  • Impulsivity and poor self control
  • Hopelessness – presence, duration, severity
  • Recent losses – physical, financial, personal
  • Recent discharge from an inpatient psychiatric unit
  • Family history of suicide
  • History of abuse (physical, sexual or emotional)
  • Co-morbid health problems, especially a newly diagnosed problem or worsening symptoms
  • Pain characteristics (severe pain)
  • psychiatric comorbidity and other psychological factors
  • substance abuse
  • ready access to analgesics
  • personal history of attempted suicide
  • feelings of isolation
  • access to lethal weapons/substances
  • Same- sex sexual orientation

Factors that may decrease the risk for suicide are also called protective factors.  These include:

  • Positive social support
  • Spirituality
  • Sense of responsibility to family
  • Children in the home, pregnancy
  • Life satisfaction
  • Reality testing ability
  • Positive coping skills
  • Positive problem-solving skills
  • Positive therapeutic relationship

Tools to screen for suicidality:

  • Columbia-Suicide Severity Rating Scale (C-SSRS)