People suffering from chronic pain may be at increased risk for suicide, according to a retrospective study in the Annals of Internal Medicine.

Using data from 18 states participating in the National Violent Death Reporting System, researchers identified 123,000 people aged 10 years and older who died by suicide over a 12-year period. Some 7% had evidence of chronic pain in 2003, rising to 10% in 2014.

The most common conditions associated with chronic pain were back pain, cancer, and arthritis. In a random sample of cases with chronic pain in which suicide notes were available, two-thirds of the notes mentioned pain as a contributing factor to the suicide.

The researchers write, "Providers should be alert to and possibly screen for depression and suicidal behaviours among patients with chronic pain." An editorialist adds, "Suicide prevention involves making effective pain interventions more available, which extends beyond providing access to opioids and should also include, if appropriate, other medications, interventional programmes, physical therapy, and psychosocial approaches."