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Pain, Sleep & Suicide: The Core Role of Interventional Care

When chronic pain begins to affect sleep patterns, induce depression, challenge functionality, or determine medication use, a comprehensive care plan may help to ward off suicidal thoughts.
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Suicide in the United States has reached a 30-year high across all age groups, not only in completed action, but in ideation, according to the National Center for Health Statistics.1 Suicide is a persistent, yet preventable, cause of death that affects men and women of all races and socioeconomic status throughout the lifespan.2 Researchers have estimated that 9.2% of the US population will have contemplated suicide at least once in their lifetime,3 and it is estimated that 60% of individuals who have contemplated suicide will follow through within the first year of the onset of ideation.2 Therefore, identifying and managing patients who are at risk for suicidal behaviors represents an important consideration for all health practitioners who have fragile patients, particularly those with chronic, severe, or intractable pain.4 Although there are many risk factors for suicide, chronic pain and related factors such as sleep disturbance and depression may strongly contribute to suicidal ideation.

Editor’s Note: In an online poll last month, Practical Pain Management invited a response to the following question: Does your practice assess for sleep disorders in your pain patients? to which 58% of respondents indicated “yes” and 42% replied “no”.

Given the health implications of disrupted sleep, particularly in patients with chronic pain conditions, gaining a deeper clinical insight and tools may be of immense value to every pain practice.

Related Research

Researchers have recently focused on the relationship between poor sleep, mental illness, and the onset of pain, all of which are associated with suicidal behaviors.4 According to Racine, one in five adults who suffer from chronic pain had suicidal ideation, and 8% to 41% of those adults attempted suicide at least once.3 A potential explanation for a sleep and suicide inter-relationship may originate from the role of sleep disturbances as a precursor to depression.5 Patients with chronic pain patients conditions have reported problems with sleep and sleep disturbances as common concerns, as well as indicated good sleep as one of the most important outcomes from effective pain treatment.6-10

In a large-scale survey investigating pain and sleep, participants experiencing pain also reported sleep difficulties significantly more often than those who did not report chronic pain.11,12 Pain has also been known to increase an individual’s risk of developing insomnia.13-15 In addition to chronic pain, researchers have examined the comorbid relationship between opioid abuse, major depressive disorder, and sleep disturbance in suicide risk.16 Researchers have sought to identify specific risk factors of chronic pain that may lead to increased likelihood for attempting suicide. Tang and Crane identified both pain duration and depression as factors that increased an individual’s suicidal ideation.16 In particular, individuals who suffered from chronic pain for more than three months reported higher ideations of self-harm or suicide.

Later life is often characterized by increased frequency of sleep complaints and higher rates of suicide, as well.17 With timing, structure, and consolidation of sleep changing tremendously in older age, greater sleep fragmentation and difficulty maintaining sleep frequently have been reported.17 For example, Goodwin and Marusic found that short-sleep was more common in older age, with an increased likelihood of suicide ideation and suicide attempts.18 Reports of decreased time spent in deeper stages of sleep, such as slow-wave or REM sleep, have been cited more often with increasing age.17,18 Furthermore, improved risk assessments for suicide and suicide prevention efforts may be needed in primary care settings. Indeed, studies have supported the common occurrence of older adults visiting their primary care physician in the final weeks (45%) and month (73%) prior to a suicide death.19

Inside the Role of Sleep  

An electroencephalogram (EEG) measures electrical activity of the brain (via placing electrodes on the head) by mapping the firing of neurons involved in brain wave activity. These brain waves are indicative of the low-voltage electrical activity transmitted through the neurons. Four basic brain-wave patterns, which differ in frequency and amplitude, may be evaluated:

  • Beta [high frequency (> 13 Hz), low amplitude) occurs in states of relative alertness
  • Alpha (8-3 Hz, higher amplitude), occurs during states of relaxed wakefulness
  • Theta (4-8 Hz, even higher amplitude) occurs during a drowsy state
  • Delta (< 4 Hz, low amplitude) occurs during deeper sleep.

In addition, EEG may be used to measure the different stages of sleep, including rapid eye movement (REM) and non-REM phases of sleep. Non-REM sleep is further broken down into four separate stages:

Last updated on: November 16, 2017
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Lumbar Lordosis and Back Pain
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