Citation

Kowal J, Wilson KG, Henderson PR, McWilliams LA. Clin. J. Pain 2014; 30(6): 463-471.

Affiliation

*Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada †School of Psychology, University of Ottawa, Ottawa, Ontario, Canada ‡Department of Anaesthesiology, University of Ottawa, Ottawa, Ontario, Canada §Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada ∥Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada ¶Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Copyright

(Copyright © 2014, Lippincott Williams and Wilkins)

DOI

10.1097/AJP.0000000000000003

PMID

24281291

Abstract

OBJECTIVES:: To examine suicidal ideation in individuals with chronic pain, especially change in suicidal thinking following interdisciplinary treatment. METHODS:: Consecutive patients (n=250) admitted to a 4-week, group-based chronic pain management program completed measures of pain intensity, functional limitations, depressive symptoms, overall distress, pain catastrophizing, self-perceived burden, and suicidal ideation at pre- and post-treatment. RESULTS:: Before treatment, 30 (12.0%) participants were classified as having a high level of suicidal ideation, 56 (22.4%) had a low level of suicidal ideation, and 164 (65.6%) reported none. Following treatment, there was a significant reduction in suicidal ideation and improvements in all other outcomes, but there were still some individuals with high (n=22, 8.8%) or low (n=28, 11.2%) levels at discharge. Patients with high suicidal ideation at baseline differed from those with no suicidal thinking on pre- and post-treatment measures of depression, distress, catastrophizing, and self-perceived burden, but not on pain intensity or functional limitations. Patients high in suicidal ideation endorsed greater pain catastrophizing and self-perceived burden than those low in suicidal thinking. Sustained suicidal ideation after treatment was associated with higher baseline levels of suicidal thinking and self-perceived burden to others, as well as a more limited overall response to treatment. DISCUSSION:: Suicidal ideation was common in individuals with chronic pain, although mostly at a low level. Interdisciplinary treatment may result in reduced suicidal thinking; however, some patients continue to express thoughts of self-harm. Future studies could examine processes of change and interventions for treatment-resistant suicidal concerns.

Language: en