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Suicide and pain


It is the anniversary of the day I wanted to die. And tried. It was a spontaneous attempt. I am told second attempts are. My first attempt, also in the month of August, was more planned, more thought out and more gruesome in my intensity. The second attempt just occurred to me and I was like Yeah let's do it, like right now. So I am going to repost something I have written on the topic to show the pain itself is a suicide risk and unmanaged pain is dangerous.

Depression Part Two by Hyperboleandahalf This is a funny but very accurate description of what depression is like.I had a horrible sense of numbness after I tried to commit suicide because oddly enough after the suicide attempt I got depressed. I say that and people don't get it. What? Clearly you must have been depressed before. Isn't suicide all about depression? But suicide can be about pain and not depression. Or a form of depression linked to pain levels I suppose. When there is a great deal of chronic pain, aggravated by circumstances that enhance it so you can't even just Be in pain, you must suffer the intense rawness of it and focus, and work and function. Horrific torment.
This is an important issue for me clearly... given I did attempt suicide and given it is a hard topic for people to understand or talk about. However, I think it is vital because clearly while I was struggling to survive and desperate with pain others are as well. And the suicide risk with chronic migraines is quite high. it is a topic that should be discussed.


Migraine, Chronic Back Pain Tied to Higher Suicide Risk

"Although undoubtedly psychiatric factors are important, there might be aspects of the pain that in and of themselves increase a person's risk," Ilgen said. "There might be something about someone with significant pain that puts them at increased risk."




The wide-ranging study, published online May 22 in the journal JAMA Psychiatry, involved more than 4.8 million people who received care from the U.S. Veterans Health Administration during fiscal year 2005. Researchers identified those suffering from chronic pain and tracked them for the next three years to see if any died from suicide.

The research team then looked for associations between suicide death -- the 10th most common cause of death in the United States -- and clinical diagnoses of chronic pain conditions, such as arthritis, back pain, migraines, neuropathy, headaches or tension headaches, fibromyalgia and psychogenic pain.

They found that all pain conditions except arthritis and neuropathy were associated with elevated suicide risk. But when they took into account the mental-health problems that chronic pain patients also had, the associations reduced for all but three types of chronic pain: back pain, migraines and psychogenic pain, which stems from psychological factors.

Dr. Elspeth Cameron Ritchie, a retired Army colonel and psychiatrist living in Washington, D.C., said the study clearly reinforces the anecdotal link between pain and suicide.
"It makes sense that pain is a risk factor for suicide," she said. "Often, suicide has several different things going on, but pain can be the straw that breaks the camel's back in terms of a person's decision not to go on."

Therapists performing a suicide-risk evaluation should consider adding a question regarding pain to the standard questions aimed at suicidal thoughts and planning, she said.
"It's not a standard question: 'Are you in pain?'" Ritchie said. "I would ask, 'Are you in pain?,' or 'Is pain an issue for you?'"

Psychogenic pain increased people's risk of suicide the most, followed by migraines and back pain. Psychogenic pain is chronic pain caused or exacerbated by mental or emotional problems, and Ilgen said it is a rare and not well understood condition.
"We think that's not so much about psychogenic pain per se, but the fact that the pain itself is poorly understood and may be poorly managed," Ilgen said. "There's not a clear treatment plan for that type of pain. It's likely that patients with this type of pain may be frustrated with their care and more hopeless and more at risk for suicide."

Hopelessness also could play a part in the elevated risk of suicide for migraine and chronic back pain sufferers -- two common problems in the United States. Back pain, for instance, is the second most common pain complaint among Veterans Health Administration patients, behind only arthritis.
"Patients with these pain conditions also may be more likely to feel hopeless and to have impairments in occupational or social functioning that could lead more directly to suicidal thoughts and behaviors," according to the study.

"Negative expectations about one's ability to effectively manage or treat pain could lead to suicidal ideation, and these effects might be greatest for certain conditions, such as psychogenic pain, that do not have clear or effective treatments and may be stigmatized," the researchers said.



-- And that is how pain leads to suicide. I wasn't depressed per sa. I was in a lot of pain working full time. Lots of frustrating. Lots of frantic pain. Lots of desperation with the pain. Then bouts of depression with status migraines because of the longer lasting acute nature of the pain and the inevitable acute sleep deprivation involved. Mood swings really revolving around pain levels. Eventually... the perfect storm. Which ironically leads me back to Depression Part Two by Hyperboleandahalf because I did survive and one would think my doctor would have thought that might have been a sign I had a pain problem that should have been dealt with or that maybe I could not function in the work place with such pain... since neither of those statements is true and I returned to full time work I sort of fell into this place beyond hopelessness, this sort of numb state of existence where I felt apparently my role was to suffer, that is what my doc wanted, what my employer wanted, what society wanted and I was expected to just endure it because suicide was a no-no. I existed there for about a year. Still just trying to survive the pain but just numb emotionally about it all because I felt their would be no end to the pain and I must simply figure out how to survive it and pretend I was okay with that. With this goal just to survive the pain day by day because it was important to others that I do so.

Until that frantic desperation started kicking in again. And I realized... how long am I going to survive like this? And I had this anxiety about my ability to cope in the long term... would not even allow myself to think about the future because it would make me anxious or depressed. And I knew what had not been depression certainly was now. A depression linked to the pain, the migraines and sleep deprivation but depression nevertheless, and now anxiety as well. Which is why I chose to see a psychologist because I didn't know how long it would be before I decided this battle wasn't worth it again. I could no longer trust myself to want to survive this existence and I had no way to make the pain less severe. Work is such a torment when it comes to chronic migraines and employers have a way of making things exceptionally worse rather than better. Existing in this survival mode gets you through the day but you never make progress, you are too tired, too strained from the pain to do anything but survive so eventually there will come a time when your employer will be particularly nasty, the pain will be particularly acute and you will be particularly sleep deprived... perfect storm. I wanted the tools to survive that storm when it hit again.

I never want to be in that place again. However, getting to that place is done by inches. You have a job. You try to do it well. It is impossible not to miss days. This does not go over well. So you try to push through the pain. Your body disagrees with this method vehemently. This is emotionally distressing. You miss more work due to aggravating everything by pushing beyond your limits. Your employer applies more stress. You try to compromise. They turn those down. You plead with your doctor for some treatment. He either tries something new and you deal with the side effects while at work which inevitably makes things worse or he puts you on leave which inevitably makes your employer more irate. And this repeats over time while you try numerous things and the situation becomes more tense and you realize it isn't working for anyone and there is no solution available for anyone. Your ability to find resolutions, cope with the mental and emotional suffering is compromised by the pain levels and sleep deprivation... so you just try to hold on. Hold on until the next drug. Hold on until the next neuro appointment. This was my existence for a very long time. A hazy time as well... just hazed by the pain. A repetitive cycle that occasionally I would stop and realize it was so damned hopeless and then just stop thinking about it.

The fact I am able to somewhat cope with the pain levels better now is solely because I am not working. There is no longer that frantic edge of desperation to it. There is just as many migraines. Just as much pain intensity. Just as much sleep issues... but I can sleep in and my cycle is erratic. I can do things like exercise because all my reserves are not consumed with work and survival. Although this is a difficult task in-itself, but I can do it. I am free to try other things. I am able to reflect on how significant a pain problem work was. I have no idea how to resolve this problem... but I have the temporary freedom to work on coping skills and other pain management techniques that you are incapable of doing when consumed by pain. I am able to see when you push past a certain point in 'functioning' with pain it has a huge toll in the long term.

When people had asked me 'how do you work every day with migraines?' and I used to say 'you get used to it' or on a bad day 'because I have no choice'... it is so understated. I don't even know how I did it. I don't even know how I survived as long as I did, but I know I didn't want to survive. I know there was nothing in my life but that survival. I know that in the end when people asked me this it brought tears to my eyes because the facade was breaking down and I wanted to say 'I can't. I have to. But I can't. I have no choice. But I can't.' The expectation is that we can. And it is there that we are doomed. With no pain management how long do people think someone will want to survive like that? Does it surprise me that chronic migraines have such a high suicide risk? Not at all. That it has to do with pain? Obviously it does.

And I recommend people see a good psychologist because it is impossible to cope with the madness of it on our own. It is impossible it seems to get a doctor to understand that their lack of treatment... while maybe it leads to no rebound headaches, but it also means many untreated migraines, more than treated often... is a Pain Problem. And this is an issue. And this issue is Not Resolved by antidepressants. Or at least not in every case. In fact, in my case, might have made things worse. Either way we are talking about acute unmanaged pain. And a psychologist, a good one, understands the relation between physical conditions, pain, lack of sleep, serotonin and depression... and whether anti-depressants are warranted or not. And other ways to help cope with all the issues. They open doors to other avenues where doctors just... seem to think we can just take the pain.
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