Department of Psychiatry and Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19106, United States.
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States.
Pain Med. 2023 Aug 1;24(8):941-948. doi: 10.1093/pm/pnad043.
Individuals with chronic pain and a co-occurring substance use disorder present higher risk of suicide, but the individual and joint impacts of chronic pain and substance use disorders on suicide risk are not well defined. The objective of this study was to exam the factors associated with suicidal thoughts and behaviors in a cohort of patients with chronic non-cancer pain (CNCP), with or without concomitant opioid use disorder (OUD).
Cross sectional cohort design.
Primary care clinics, pain clinics, and substance abuse treatment facilities in Pennsylvania, Washington, and Utah.
In total, 609 adults with CNCP treated with long-term opioid therapy (>/= 6 months) who either developed an OUD (cases, n = 175) or displayed no evidence of OUD (controls, n = 434).
The predicted outcome was elevated suicidal behavior in patients with CNCP as indicated by a Suicide Behavior Questionnaire-Revised (SBQ-R) score of 8 or above. The presence of CNCP and OUD were key predictors. Covariates included demographics, pain severity, psychiatric history, pain coping, social support, depression, pain catastrophizing and mental defeat.
Participants with CNCP and co-occurring OUD had an increased odds ratio of 3.44 in reporting elevated suicide scores as compared to participants with chronic pain only. Multivariable modeling revealed that mental defeat, pain catastrophizing, depression, and having chronic pain, and co-occurring OUD significantly increased the odds of elevated suicide scores.
Patients with CNCP and co-morbid OUD are associated with a 3-fold increase in risk of suicide.
患有慢性疼痛和同时存在的物质使用障碍的个体自杀风险较高，但慢性疼痛和物质使用障碍对自杀风险的个体和联合影响尚未明确。本研究的目的是检查患有慢性非癌症疼痛（CNCP）的患者队列中与自杀想法和行为相关的因素，无论是否同时存在阿片类药物使用障碍（OUD）。
横断面队列设计。
宾夕法尼亚州、华盛顿州和犹他州的初级保健诊所、疼痛诊所和药物滥用治疗设施。
共有 609 名接受长期阿片类药物治疗（>/= 6 个月）的患有 CNCP 且患有或未患有 OUD 的成年人（病例组，n = 175；对照组，n = 434）。
预测结果是 CNCP 患者的自杀行为升高，这是通过修订后的自杀行为问卷（SBQ-R）评分 8 或以上来表示的。CNCP 和 OUD 的存在是关键预测因素。协变量包括人口统计学、疼痛严重程度、精神病史、疼痛应对、社会支持、抑郁、疼痛灾难化和心理挫败感。
与仅患有慢性疼痛的患者相比，患有 CNCP 和并发 OUD 的患者报告出现升高的自杀评分的比值比为 3.44。多变量模型显示，心理挫败感、疼痛灾难化、抑郁以及患有慢性疼痛和并发 OUD 显著增加了出现升高的自杀评分的几率。
患有 CNCP 和共病 OUD 的患者自杀风险增加 3 倍。
