As any chronic-pain patient knows, it's easy to feel helpless when in pain,
to be pessimistic about ever escaping it, and to find it difficult to keep
pain out of your mind—in short, to "catastrophize" it.
In addition to being a poor strategy for coping with pain, catastrophizing
has a potentially lethal downside: it can spark suicidal thoughts, a new
investigation suggests. The inquiry was headed by Robert Edwards, Ph.D., an
assistant professor of psychiatry at Johns Hopkins University. Results are in
press with the journal Pain.
Edwards and his coworkers assessed 1,512 chronic-pain subjects to gauge
their psychosocial functioning and to determine how much pain they
experienced, how they coped with it, and whether they thought about committing
suicide. The investigators then looked for associations between various
factors and subjects' suicidal thoughts.
Almost a third of the subjects reported some form of recent suicidal
ideation. To the researchers' surprise, there was only a modest link between
suicidal thoughts and pain severity or duration. However, suicidal thoughts
were strongly linked to depression and catastrophizing. Moreover, even when
subjects' depression was taken into consideration, the link between suicidal
thoughts and catastrophizing remained potent.
"These are the first findings to suggest a unique (for example,
independent of pain severity or depressive—symptomatology) association
between pain-coping strategies and suicide-related cognitions in the context
of chronic pain," Edwards and his group concluded in their study
"This study addresses a problem of tremendous public health
importance—suicide in chronic-pain patients," Jordan Karp, M.D., a
University of Pittsburgh investigator with a special interest in pain and
emotions, told Psychiatric News. "It appears that those
patients who have symptoms of depression and are catastrophizers...
are at greatest risk of having suicidal ideation. [Thus] it's our duty as
clinicians to, one, treat the comorbid depression, and, two, provide or refer
the patients for psychotherapy that specifically addresses these cognitive
distortions to reduce their risk of suicide."
In fact, in a previous inquiry Edwards and his team found that
cognitive-behavioral therapy (CBT) can reduce catastrophizing in chronic-pain
patients. The researchers will now explore not only whether CBT can reduce
catastrophizing in these patients, but also whether such a reduction might
reduce the frequency of suicidal thoughts, Edwards told Psychiatric
Still another question Edwards and his group is interested in answering, he
said, is whether any medications can counter catastrophizing in chronic-pain
patients, and if so, whether a medication-induced reduction in catastrophizing
would in turn reduce the frequency of suicidal ideas.
For instance, a relatively new class of antidepressants—the combined
selective serotonin-norepinephrine reuptake inhibitors (SNRIs)—have been
found to combat depression and various kinds of pain as the tricyclic
antidepressants do, but without the latter's side effects (Psychiatric
News, March 3). Thus, it is possible that the SNRIs might be able to
counter catastrophizing and suicidal ideas as well, Edwards hypothesized. He
and his team have already found that the tricyclics are not effective in
countering catastrophizing and pain in neuropathic pain subjects.
The study was funded by the National Institutes of Health.
An abstract of "Pain-Related Catastrophizing as a Risk Factor
for Suicidal Ideation in Chronic Pain" can be accessed at<www.sciencedirect.com>
by clicking on "P," then "Pain." ▪