Chronic Pain's Role in Suicide Risk Assessments: A Call for Action

Chronic pain, a prevalent yet often overlooked issue in India, has been identified as a significant risk factor for suicide, necessitating its inclusion in formal suicide risk assessments. Experts emphasize that understanding the relationship between chronic pain and mental health is crucial for identifying individuals at risk and implementing effective interventions.

Chronic pain affects millions across India, often presenting as a physical ailment while obscuring the mental distress it causes. According to the World Health Organization (WHO), India recorded a suicide mortality rate of 16.5 per 100,000 individuals in 2016, significantly above the global average. Studies indicate that chronic pain is a critical contributor to these figures.

Research published in the *Lancet Psychiatry* has highlighted the need for chronic pain to be recognized as an independent suicide risk factor. Despite substantial neurobiological and epidemiological evidence, many standardized suicide screening tools exclude chronic pain from their assessments, creating a significant gap in clinical practice.

Dr. Ramdas Ransing, Associate Professor of Psychiatry at AIIMS Guwahati, states, "The relationship between chronic pain and suicide risk is complex and bidirectional—chronic pain can elevate the risk of suicide, and individuals at risk may present with somatic symptoms like persistent pain." This complexity often leads to chronic pain being mischaracterized solely as a medical issue, neglecting its psychological implications.

Prarthana Saraswathi, a consultant psychiatrist at Rela Hospital in Chennai, notes, "Pain is not just a physical sensation; it’s deeply emotional, especially within the context of India, where mental health stigma is prevalent." Many individuals experiencing chronic pain express their suffering through passive death wishes rather than explicit suicidal ideation. This is particularly common among women with chronic conditions that impair their ability to fulfill caregiving roles.

Current suicide risk tools, such as the Columbia-Suicide Severity Rating Scale and the Beck Depression Inventory, predominantly focus on psychiatric symptoms and often overlook chronic pain. Mithun Prasad, a consultant psychiatrist at SIMS Hospital in Chennai, explains, "These tools fail to flag high-risk individuals because chronic pain isn’t part of the checklist." This oversight can result in inadequate support for those who are suffering.

International studies suggest that chronic pain, even without a formal psychiatric diagnosis, can significantly increase suicide risk. Dr. Prasad adds, "Pain doesn’t just exist in the body; it seeps into a person’s identity and their engagement with life. People may stop planning for the future and express feelings of despair. These are red flags that should not be ignored."

Despite the challenges associated with integrating chronic pain into suicide risk assessments, experts advocate for this change. The subjective nature of pain and the lack of training among clinicians in pain psychology pose significant barriers. However, the benefits of early identification and intervention could outweigh these challenges.

Astik Joshi, a child and adolescent psychiatrist in New Delhi, calls for a multidisciplinary approach to care. He argues that pain should be viewed as a biopsychosocial risk factor, necessitating its inclusion in suicide assessment models. "Suicide assessments must account for long-term physical suffering, especially when paired with emotional exhaustion and isolation," he asserts.

Experts suggest that a national program linking chronic pain to suicide prevention is essential. This could involve training workshops, integrated pain and mental health clinics, and routine cross-referrals between specialists. The identification of chronic pain should be prioritized in clinical settings, followed by comprehensive assessments that include both physical and psychological evaluations.

In conclusion, the integration of chronic pain into suicide risk assessments is not merely beneficial; it is essential for effective intervention strategies. Addressing the emotional and psychological aspects of chronic pain could significantly mitigate suicide risks in vulnerable populations, ultimately saving lives in a country where mental health resources remain critically under-resourced.

For those in need of support, various suicide helplines are available across India, offering assistance to individuals struggling with mental health issues related to chronic pain.