1. Chronic pain may be an important contributor to suicide
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Chronic pain may be an important contributor to suicide. Nearly 9 percent of people who died by suicide in 18 states from 2003 to 2014 had documentation of chronic pain in their incident records. Findings from the National Violent Death Reporting System (NVDRS) are published in Annals of Internal Medicine.
More than 25 million adults in the U.S. have some level of daily pain, and 10.5 million have considerable pain every day. Chronic pain has been associated with risk factors for suicide, but previous studies primarily examined nonfatal suicidal behaviors, rather than suicide deaths associated with chronic pain or the characteristics of such deaths.
Researchers from the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention analyzed data from 18 states participating in the NVDRS for at least one year from 2003 to 2014. The NVDRS details characteristics of violent deaths, including suicide, and the circumstances identified as directly contributed to the death. The researchers found that of 123,181 suicide decedents included in the study, 10,789 (8.8 percent) had evidence of chronic pain, and the percentage increased from 7.4 percent in 2003 to 10.2 percent in 2014. More than half (53.6 percent) of suicide decedents with chronic pain died of firearm-related injuries and 16.2 percent by opioid overdose. Although not mutually exclusive, back pain, cancer pain, and arthritis accounted for a large proportion of pain conditions in persons who died by suicide. Likewise, anxiety and depression were diagnosed more often in suicide decedents with pain than in those without it.
The researchers showed that among suicide decedents with chronic pain for whom toxicology results were available, opioids were much more likely to be present at the time of death than in those without pain. The author of an accompanying editorial suggests that the role of opioids in suicide risk should be explored and that suicide prevention should be a component of care for those suffering from chronic pain.
2. Survey shows that documentation is often lacking for justifying opioid therapy
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Data from a national survey found that many outpatient opioid prescriptions had no documented medical indication. A brief research report is published in Annals of Internal Medicine.
Medical use of opioids has increased dramatically over the past 2 decades, far exceeding increases in the prevalence of pain. This discrepancy has raised concerns about the appropriateness of physicians' prescribing practices and whether patients' medical indications justify opioid therapy.
Researchers from Harvard Medical School and the RAND Corporation studied data from the National Ambulatory Medical Care Survey (NAMCS), to determine the percentage of opioid prescriptions with a documented medical indication between 2006 and 2015 and to identify conditions commonly associated with opioid prescribing in outpatient care. The researchers found that opioids were prescribed at an estimated 809 million visits across the U.S. during this time period, of which 5.1 percent were assigned a diagnosis of cancer-related pain, 66.4 percent were assigned a non-cancer pain diagnosis, and no pain diagnosis was recorded for the remaining 28.5 percent of prescriptions.
According to the researchers, their results were not driven by constraints on the survey form. Their findings suggest that providers may currently fall short of transparently and accurately documenting the justification for opioid therapy.
Media contact: For an embargoed PDF, please contact Lauren Evans at email@example.com. To interview the lead author, Tisamarie Sherry, MD, PhD, please contact Ekaterina Pesheva at firstname.lastname@example.org.
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A Student Reflection on Doctoring With Confidence: Mind the Gap
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Ideas and Opinions
Annals Understanding Clinical Research: Interpreting Results With Large P Values
Joshua M. Liao, MD, MSc; Catharine B. Stack, PhD; Steven Goodman, MD, MHS, PhD
Special Article: Research and Reporting Methods