Chronic Pain Leading Risk Factor for Suicide by U.S. Veterans
/By Pat Anson
Chronic pain is the leading risk factor for suicide by U.S. veterans, according to a comprehensive new report by the Department of Veterans Affairs that also identified poor sleep, declining physical activity, and other health problems that significantly raise the risk of a veteran dying by suicide.
VA researchers estimate there were over 6,400 veteran suicides in 2022, an average of 17.6 suicides per day. The suicide rate for veterans (34.7 per 100,000) is twice the rate among non-veterans (17.1 per 100,000).
While those are alarming figures, there are some signs of progress. The number of veteran suicides has been trending downward since 2018, with a notable decline in the suicide rate among female veterans (-24.1%), homeless veterans (-19.1%) and younger veterans (-3.8%) in 2022.
Dept. of Veterans Affairs
The VA report goes into great detail on the methods used to commit suicide (a firearm is the most likely), and whether a deceased veteran had social, financial, mental health, or substance abuse problems.
But surprisingly little attention is paid to the leading risk factor: chronic pain. Only on Page 44 of the report is it disclosed that 53.8% of veterans who died by suicide reported pain in the year prior to their death. Pain isn’t even mentioned in a VA news release on the report.
“Every veteran suicide is a tragedy,” said Secretary of Veterans Affairs Denis McDonough in that news release. “There is nothing more important to VA than ending veteran suicide — and that means providing veterans with the care they need, wherever they need it, whenever they need it.”
‘The Pain Is Forever’
Many veterans in pain say they can’t get the care they need in the VA health system, which has worked to reduce opioid prescribing and expand the use of non-opioid alternatives. The VA updated its clinical practice guideline in 2022 to strongly recommend against long-term opioid therapy, especially for younger veterans.
“The VA makes you go through re-education camp for pain meds for chronic pain for injuries and diseases,” one veteran told us. “They make doctors refuse to prescribe pain meds and they made a whole new industry punishing sick people. Anyone who joins the military should know the hell they will be put through if they are injured and the pain is forever.”
“It's amazing how VA loves to play with my treatment for chronic pain. If I get tapered down again (for the 5th time) I don't know what I will do. It makes the heroin option look like the best way to go,” said another veteran. “And they can't understand why so many vets are killing themselves.”
“Chronic pain is known to be both common amongst individuals who die by suicide and a frequent issue identified as a reason for ending one’s life,” says Anne Fuqua, a chronic pain sufferer who has been tracking pain patient suicides for several years.
“If VA claims preventing suicide is a top clinical priority, when chronic pain is present, they should treat it aggressively, employing whatever medications and interventions are needed to best treat an individual without being handicapped by artificial limits that have no relationship to the individual veteran’s clinical situation.”
More Research Needed
Risk factors that contribute to suicide are difficult to measure, largely due to the difficulty of assessing possible causes for a veteran who has passed away and can’t speak for themselves. Suicide is often a taboo topic for a veteran’s surviving family and loved ones.
One expert says the VA deserves credit for trying to tackle such a complex problem.
“We have to demand that every health care system, not just the VA, recognize the special risk to suicide that occurs in people who have all of these risk factors, whether it’s sleep, impulsivity, an unsecured firearm, or pain,” said Stefan Kertesz, MD, an internist at the Birmingham VA Medical Center and Professor of Medicine at the University of Alabama at Birmingham.
“In many health care settings, efforts to quantify the pain experience have been made taboo. That's a horrible mistake. Not asking about something doesn't make the problem go away.”
Kertesz is leading a study of suicides among veterans and civilians, and is trying to connect with survivors who can talk about changes in healthcare and social functioning that occurred prior to a loved one’s death.
“We need to ask, carefully and systematically, about what is going on in the lives of folks who are in distress. We need to ask how we can be of help,” said Kertesz.
“The prominence of pain in the VA’s statistical report does not mean pain is the primary driver of suicide. Most folks with pain, after all, don’t consider suicide. But it is a reminder that we can’t ignore pain or minimize it or pawn it off on the patient as their little problem to solve. We need to be present and we need to ask, relentlessly, what the heck is going wrong and how can we do better?”
If you have lost someone with pain to suicide, you can learn more about the study by clicking here or on the banner below. Participants who are interviewed may be eligible for a cash payment of $100.
