Information in this article may be triggering to some people. If you or a loved one is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255. If you or a loved one is in immediate danger, call 911.
Living with chronic pain often means managing a huge emotional burden. For some people, this includes dealing with suicidal ideations, or thoughts about killing oneself that may or may not include a plan.
“Having chronic pain means you are living in a physical and psychological state that you can’t control, and there’s a hopelessness to it,” says clinical psychologist Laurie Ferguson, PhD, Director of Education Development at the Global Healthy Living Foundation.
“It’s very easy to fall into a bad mental health/emotional place when dealing with pain day in and day out,” CreakyJoints member Angélica V. said on Facebook. She shared feeling frustration that often evolves into desperation and hopelessness.
AnnMarie Giannino-Otis, founder of What Would You Miss, lives with MS and breast cancer and echoes these sentiments. “The pain, the treatments, and the ‘burden’ you feel you’re putting on people — some days you want to give up,” she says.
Having suicidal thoughts is not rare, occurring in roughly 20 percent of people with chronic pain, according to a Psychological Medicine study.
A recent study published in the journal Annals of Internal Medicine analyzed the presence of chronic pain in people who died by suicide. It included data from 2003 to 2014 on 123,181 people across 18 states. Researchers found that 8.8 percent of cases included evidence of chronic pain. The most common conditions associated with suicide were back pain, cancer, and arthritis, with the majority of decedents having more than one condition. (The researchers noted that the results probably underrepresent the true percentage of suicide deaths who had chronic pain, given the nature of the data and how it was captured.)
Several studies have also found an increased risk of suicidal behaviors, including suicidal ideation, suicide attempts, and completed suicide, in people with fibromyalgia.
What Are Suicidal Thoughts?
Suicidal ideations typically fall into two categories: passive and active. “A passive thought might be ‘I wish a piano fell on me today,’ or ‘I wonder if the world would be better without me,’ which is a little more determined,” says Afton L. Hassett, PsyD, a licensed clinical psychologist and an Associate Research Scientist in the Department of Anesthesiology at the University of Michigan in Ann Arbor.
However, even fleeting passive thoughts like this suggest that you need to talk to someone, even if it’s a good friend. “It’s a sign that you’re really feeling overwhelmed,” Dr. Hassett says.
Active thoughts involve starting to have a plan: thinking about how, when, and where you’ll do it. That’s when you need professional care.
“I was looking up ways to end my life, reading stories of others who had made attempts,” recalls Eileen Davidson, a rheumatoid arthritis patient advocate and blogger at ChronicEileen.com. “I couldn’t shut off the thought of giving up because I felt so hopeless and trapped.”
If you are having any suicidal thoughts (even fleeting ones), Dr. Ferguson urges that you take yourself seriously. “It matters,” she says. “People love you and want to try to help.”
Risk Factors for Suicide
If you’re dealing with chronic pain, you may also be dealing with some of the major risk factors for suicide, including co-occurring anxiety and depression, anger, isolation, and sleep disturbances.g
Depression can certainly contribute to suicidal ideation, putting feelings of hopelessness in “capital letters and bold,” explains Dr. Ferguson. “If your neurochemistry is already lacking, you don’t have the neurotransmitters that are going to help you feel better mentally, even if you feel better physically.”
Chronic pain can also cause life disruption; for example, many people are on disability or become unemployed, which are huge risk factors for suicide, says Dr. Hassett. She adds: “People with chronic pain often feel that those around them don’t understand them and they feel isolated, which is multiplied with the strange times we’re living in.”
However, feeling isolated, having catastrophic thoughts, and being in denial about having chronic pain are all modifiable factors and amenable to therapy, notes Dr. Hassett. “We can help people think about how they are thinking,” she says.
If you’re having suicidal thoughts — with or without any of the have the following risk factors for suicide — it’s important to seek immediate help:
- Depression, other mental disorders, or substance use disorder
- Having a chronic illness or chronic pain
- A prior attempt at suicide
- Family history of a mental disorder or substance use disorder
- Family history of suicide
- Family violence (physical or sexual abuse)
- Having guns or other firearms in the home
- Being exposed to others’ suicidal behavior, such as that of family members, peers, or celebrities
What to Do If Someone You Love Is at Risk
Suicidal ideations don’t happen overnight; they build up. However, since you can’t possibly see what your loved one is experiencing inside, it’s important to tune into the following outward signs that may indicate that your loved one is thinking about or contemplating suicide:
- Giving away important possessions
- Withdrawing from family and friends
- Talking about wanting to die or kill themselves
- Talking about feeling empty, hopeless, or having no reason to live
- Making a plan or looking for a way to kill themselves (stockpiling pills or buying a gun)
- Talking about great guilt or shame
- Talking about feeling trapped (feeling like there are no solutions)
- Feeling unbearable pain (emotional or physical)
- Talking about being a burden to others
- Misusing alcohol or drugs
- Changing eating and/or sleeping habits
- Showing rage or talking about seeking revenge
- Impulsive or reckless behavior
- Talking, thinking, or writing about death often
- Extreme mood swings (from very sad to very calm or happy)
- Saying goodbye to friends and family
- Putting affairs in order (such as making a will)
If you notice any of these warning signs, communication is key. Dr. Ferguson suggests saying something like: “I’ve heard you mention a few times that you think the world would be better off without you. Are you thinking about suicide? Can you talk about it?”
It’s a myth that you’ll give someone the idea to kill themselves if you ask about it. “If they are thinking about suicide, they are thinking about it all of the time — you’re not going to put something in their heads,” says Dr. Ferguson.
Often, people who are having suicidal ideation are very relieved to tell another human being, adds Dr. Hassett. “They want someone to ask; it’s a relief.”
Beyond communication, keeping your loved one safe also means doing everything you can to make access to means very difficult, says Dr. Ferguson. “If you have firearms, get them out of the house or lock them up. If you have medications, lock them up.”
In the Annals of Internal Medicine study, more than half of suicides involved firearms (54 percent) and many involved opioid overdose (16 percent).
How to Manage Emotional Pain When You Have Chronic Pain
We reached out to experts, along with patients who have struggled with suicidal ideation, to provide some tips for coping with the emotional burden of chronic pain. This isn’t to say that all of these ideas will work for you, but they can give you help and hope.
“I admit I live with a bit of fear of becoming lost again in a dark place like I was stuck in — with chronic illness and depression I almost expect myself to get sick again — but I have become better equipped with skills and understanding my warning signs to get the help I need,” says Eileen.
1. Talk to someone
“Reaching out [for help] is a sign of strength,” says AnnMarie.
Consider talking to a family member or friend, nurse, spiritual leader, or social worker. “Find someone who won’t get wildly emotional or hysterical, but someone who can really listen for your concerns and feelings,” says Dr. Ferguson. Another option: Call a suicide hotline. “The freedom of anonymity can be a tremendous relief,” says Dr. Ferguson.
It’s also important to talk to a mental health professional who can help you “find ways to interrupt obsessive, intrusive thoughts, think differently, and introduce some new or different activities or ways of living that you couldn’t think of on your own,” Dr. Ferguson says.
2. Prioritize self-care and support
One of the most important parts of managing the emotional burden of chronic illness is having “a support system and community to lean on during difficult times,” writes CreakyJoints member Teresa S. She makes sure to meditate and do something kind for herself; “even if I have to force myself to listen to music or read a book.”
“It’s the small, small things that can connect us back to hope,” says Dr. Ferguson, who recommends going outside and feeling the sun, or listening to music.
Or try this: Text five people who you haven’t spoken with in a while, says Dr. Hassett. Write, “just thinking of you,’ or send a picture of both of you. “They’re probably lonely, too,” she says.
3. Keep a gratitude journal or log
On a daily basis, write down a few things for which you’re grateful, whether it’s a simple cup of coffee or a conversation with a friend.
“When we’re in a depressive state, we forget to look for the positive things in life and dwell on the negative,” says Dr. Hassett. “We can take direct action to start changing how we feel; we’re not powerless to our feelings.”
You don’t need a formal journal either — you can download a free gratitude journal app on your phone or just make a running list on the notes app on your phone.
4. Try activity scheduling
Pick two or three things a week that you love to do and put them on your calendar. A few examples: watching reruns of a favorite TV show, a Zoom dinner with friends, playing a board game with a family member, or going for a walk on a scenic trail or neighborhood route.
“Committing to having fun in your life is a powerful intervention,” says Dr. Hassett. “Positivity is going to help with your pain and your sleep.”
5. Have a safety plan
AnnMarie urges people with chronic pain to have a safety plan, which includes writing down the following:
Triggers for thoughts of suicide, including situations, thoughts, or feelings. “If you know there are certain triggers or warning signs that you can recognize, or when you’re more likely to experience suicidal thoughts, you can prepare to use your safety plan at these times,” AnnMarie says.
Things that help build your emotional reserve, which can include baking, coloring, creative writing, exercise, gardening, and meditation.
Reasons to live. “My son keeps me going,” Eileen says. “The love from being a mother really helped heal a lot of my inner wounds.”
People you can call, including crisis lines like the National Suicide Prevention Lifeline (1-800-273-TALK (8255) and the Crisis Text Line’s number (741741).
6. Ask about medication
If you’re dealing with chronic pain and also feel a sense of hopelessness, overwhelming fatigue, or are highly irritable, these are red flags of depression and warrant a call to your doctor.
“You’re already working to manage the chronic pain; you don’t have to work so hard to manage all of those difficult thoughts all of the time,” says Dr. Ferguson. “Antidepressants aren’t a magic bullet, but they can help provide some relief.”
If you’ve started a new medication and then begin to notice suicidal thoughts, it’s important to call your doctor right away. Steroids and even some antidepressant are known to cause suicidal ideation, says Dr. Hassett.
7. Tell your story
Sharing your story, and what has helped you, can help change the conversation about suicide from one of stigma and tragedy to one of hope and healing. In addition to talking to friends and family, consider sharing about how you’re feeling and how you’re getting help in a social media group. Before you post, ask yourself these questions, advises the National Suicide Prevention Hotline: Am I ready to share? What do I hope to achieve, and for who? Steer clear of any groups with unsafe content, including harmful messaging or misinformation, bullying, images or graphic descriptions of suicide methods, or suicide pacts or notes.
“We often tend to hear the despair narratives, which are very real, but there are folks that have walked this path and taken a different fork,” says Dr. Ferguson, who urges CreakyJoints members to share their stories.
It will be cathartic for you and the chronic pain community. And, in fact, studies have found that when you acknowledge and talk about suicide, it reduces suicidal thoughts.
“People underestimate the power of talking and being heard, to have someone validate how painful it is, how stuck you feel, and like it feels like there’s no way out,” says Dr. Ferguson.
8. Don’t give up
“When people get to the point of suicide, they feel like they’ve explored every single avenue and person and there doesn’t seem to be an alternative,” says Dr. Ferguson. “It’s understandable that living with chronic pain is overwhelming. But I urge anyone who is having these consistent, persistent, and understandable thoughts to be willing to give it one more try.”
Get Mental Health Support
We understand how difficult it can be to cope during these uncertain times, especially when you are living with chronic illness. It is important to talk to someone who can help. You should contact your primary care physician or your insurance provider to learn about the supportive resources that are available to you. Here are other mental health resources for your reference:
- To find local support groups and services, you can call 1-800-950-NAMI (6264) or email firstname.lastname@example.org. The National Alliance on Mental Illness HelpLine can be reached Monday through Friday, 10 AM to 6 PM ET.
- For a counselor or therapist in your area, view the resources page at Mental Health America: Finding Therapy.
- If your mental health concern is an emergency for you or someone else, you should call 911.
- If you are having suicidal thoughts or have or are thinking of hurting yourself, you should call the National Suicide Prevention Lifeline’s 24-hour toll-free crisis hotline, 1-800-273-TALK (8255).
Watch: Rheumatoid Arthritis, Depression and Mental Health
This video is part of an educational project from researchers at Yale University, Berkshire Medical Center, Carnegie Mellon University, Hospital for Special Surgery, CreakyJoints and the Global Healthy Living Foundation, and ArthritisPower. It was made possible with support from the Rheumatology Research Foundation. Watch more videos from this series here.
Dazzi T, et al. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine. December 2014. doi: https://doi.org/10.1017/S0033291714001299.
Gold MS, et al. Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. JAMA. April 6, 2005. doi: https://doi.org/10.1001/jama.293.13.1635.
Harris LM, et al. Sleep disturbances as risk factors for suicidal thoughts and behaviours: a meta-analysis of longitudinal studies. Scientific Reports. August 2020. doi: https://doi.org/10.1038/s41598-020-70866-6.
Interview with Afton L. Hassett, PsyD, a licensed clinical psychologist and an Associate Research Scientist in the Department of Anesthesiology at the University of Michigan in Ann Arbor
Interview with Laurie Ferguson, PhD, clinical psychologist and Director of Education Development at the Global Healthy Living Foundation
Jimenez-Rodríguez I, et al. Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain. Neuropsychiatric Disease and Treatment. April 2014. doi: https://doi.org/10.2147/NDT.S57596.
Petrosky E, et al. Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System. Annals of Internal Medicine. October 2018. doi: https://doi.org/10.7326/M18-0830.
Storytelling for Suicide Prevention Checklist. National Suicide Prevention Hotline. https://suicidepreventionlifeline.org/storytelling-for-suicide-prevention-checklist.
Suicidal Behavior and Ideation in Adults. UpToDate. October 2020. https://www.uptodate.com/contents/suicidal-ideation-and-behavior-in-adults.
Suicide Prevention. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml.
Tang NKY, et al. Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links. Psychological Medicine. May 2006. doi: https://doi.org/10.1017/S0033291705006859.