A 57-year-old male with chronic pain syndrome, anxiety disorder, and hypertension is seeking mental health counseling

Patients with chronic pain have a substantially higher risk of suicidal ideation and behavior than the general population. A systematic review by Tang and Crane reported that the risk of death by suicide in chronic pain patients is at least double the rate in the general population.[1] Chronic pain patients have a lifetime prevalence of suicide attempt ranging between 5% and 14%, and the prevalence of suicidal ideation is about 20%.[1] They identified several risk factors for suicidality in chronic pain, the type, intensity, and duration of pain and sleep-onset insomnia cooccurring with pain. They also concluded that helplessness and hopelessness about pain, the desire for escape from pain, pain catastrophizing and avoidance, and problem-solving deficits are important psychologic processes to the understanding of suicidality in chronic pain.[1] Edwards et al highlighted the magnitude of depressive symptoms and the degree of painrelated catastrophizing, a maladaptive cognitive/emotional pain-coping strategy, as the most consistent predictors of the presence and degree of suicidal ideation.[2] Psychiatric disease is a well-known risk factor for suicide; a great number of the chronic pain patient population suffers from comorbid psychiatric disorders. The greatest risk factors for suicidality are major depressive disorders, dysthemia disorders, and substance use disorders.[3] Drug overdose is the most commonly reported plan and method of suicide attempt.[4] This finding highlights the importance of routine evaluation and monitoring of suicidal behavior in chronic pain particularly for patients with family histories of suicide, and those taking a high dose of opioid medications.[4]