Hooley Jill M, Franklin Joseph C, Nock Matthew K
Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA,
Curr Pain Headache Rep. 2014;18(8):435. doi: 10.1007/s11916-014-0435-2.
Chronic pain conditions are associated with an elevated risk for suicide. Of particular importance is the question of why pain conditions might be linked to increased suicide risk. We discuss the association between chronic pain and psychological pain, particularly in the context of depression, and the use of suicide as an attempt to escape from what is perceived as unbearable suffering. We also consider the role that chronic pain may play in increasing the capacity for suicide. Bridging across research areas and drawing on the interpersonal-psychological theory of suicide, we suggest that chronic pain may facilitate the development of a key risk factor for suicide: fearlessness about death. Given that chronic pain can lead to (and be exacerbated by) depression, engender hopelessness, facilitate a desire for escape through death, and erode the natural fear of dying, clinicians must be aware of psychological processes that can combine to create elevated suicide risk in patients with chronic pain, and they should also assess and treat suicide risk factors in these patients.
慢性疼痛状况与自杀风险升高相关。特别重要的是疼痛状况为何可能与自杀风险增加有关这一问题。我们讨论慢性疼痛与心理疼痛之间的关联，尤其是在抑郁症背景下，以及将自杀作为逃避被视为无法忍受的痛苦的一种尝试。我们还考虑慢性疼痛在增加自杀能力方面可能发挥的作用。跨越研究领域并借鉴自杀的人际心理理论，我们认为慢性疼痛可能会促进自杀关键风险因素的形成：对死亡无畏。鉴于慢性疼痛可导致（并因）抑郁症而加重，产生绝望情绪，促使通过死亡寻求解脱的欲望，并削弱对死亡的天然恐惧，临床医生必须意识到可能共同导致慢性疼痛患者自杀风险升高的心理过程，并且他们还应评估和治疗这些患者的自杀风险因素。
