Back pain can be a very disabling problem that alters a person’s life in so many ways. Quality of life suffers. Depression is common. Suicide may be tempting. But how often do people with back pain really end their lives because of it? And how does that compare to the number of people who commit suicide who don’t have back pain?
Researchers from Finland used hospital discharge records to investigate suicide among people with back pain. They collected information from hospital charts for patients with and without musculoskeletal diseases and compared suicide rates. They also looked at differences in age, gender, history of mental illness, method of suicide, and alcohol and other drug abuse at the time of the suicide.
There were over 2300 suicides in Northern Finland between 1988 and 2007. There were actually probably more than that but this is how many patients treated at a hospital for musculoskeletal problems committed suicide. The data was taken from the required hospital discharge records.
Analysis of the data collected showed that men were four times more likely to complete a suicide than women. Autopsy reports were used to assess the use of alcohol or other drugs at the time of the death.
Method of suicide was divided into two groups: violent (e.g., hanging, drowning, shooting, jumping from a height, wrist cutting) or nonviolent (e.g., poisoning, gas). Poisoning referred to overdose of alcohol, other nonprescription drugs, and/or medications. Common medications used to commit suicide included antipsychotics, antidepressants, sedatives, and analgesics (pain relievers).
Most of the suicides (78.8 per cent) were among people without any hospital-treated back (or other musculoskeletal) pain disorders. Those who did have a musculoskeletal disorder and killed themselves were much older than the people who killed themselves who did not have back (or other musculoskeletal) pain. The most common types of other musculoskeletal disorders included rheumatoid arthritis and knee pain.
The group with back pain (and other musculoskeletal pain disorders) who committed suicide did so most often in a nonviolent way. Women were especially more likely to use a drug overdose compared with hanging or self-inflicted shooting among men. And women with back pain were more likely to be drinking when they died.
What else did they find? Well, men of all ages with back pain or musculoskeletal disorders were hospitalized more often than any others for depression and substance abuse. Whether the back pain came first and led to depression and drug abuse or the other way around was not known.
Turning the data around, they took a closer look at the 21.2 per cent of suicides that were linked with back or musculoskeletal pain. It turns out that these folks were 14 times more likely to commit suicide than patients in the general population.
When drug overdose was the chosen method of suicide, dextropropoxyphene was used in half the cases. This medication is prescribed as a pain reliever but it is in the drug category of opioids (narcotics). Sold under different brand names, dextropropoxyphene has been taken off the market in Europe and the United States. It is still available and widely used in Finland for chronic pain.
In summary, research has shown that suicide is common among people who suffer chronic pain. But there is wide variation in numbers of suicide from different causes of chronic pain. By taking a look back (a retrospective study), this report highlighted the role of age and overdose with narcotics and subsequent suicide in patients with back pain (and other musculoskeletal disorders).
The authors suggest that physicians treating adults (especially older adults) remember that drug overdose is the most common way patients with musculoskeletal disorders kill themselves. Therefore, dispensing prescription drugs for pain should be done carefully and monitored closely.