Ep 11. What’s the Harm?

Trigger warning: This episode deals with the topic of suicide.

Dan and I have an interesting and important discussion that bridges the gap between patients’ clear and obvious frustrations with how different versions of “it’s in your head” affect them and providers’ lack of awareness around the issue. How can this be the case? And how does being told pain is in your head possibly increase suicidal thoughts by 500-1200%? We explain how it occurs and compare it to what we’d accept from other therapies.

Chronic pain patients have a 25% likelihood of suicidal thoughts in the last 2 weeks. If how we explain pain increases that risk in as few as 5% of patients, we might need to think of another explanation.

If you are a patient who has had suicidal ideation recently, please reach out to one of the below suicide support lines in the show notes. We need you.

Episode References:

  • Racine M. Chronic pain and suicide risk: A comprehensive review. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018 Dec 20;87(Pt B):269–80.

  • Stone L. Blame, shame and hopelessness: medically unexplained symptoms and the “heartsink” experience. Aust Fam Physician. 2014 Apr;43(4):191–5.

  • Burke MJ. “It’s All in Your Head”—Medicine’s Silent Epidemic. JAMA Neurol. 2019;76(12):1417–1418. doi:10.1001/jamaneurol.2019.3043

  • Ejdemyr I, Hedström F, Gruber M, Nordin S. Somatic symptoms of helplessness and hopelessness. Scand J Psychol. 2021 Jun;62(3):393–400.

  • Ashar YK, Gordon A, Schubiner H, Uipi C, Knight K, Anderson Z, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022 Jan 1;79(1):13–23.

  • Ashar YK, Lumley MA, Perlis RH, Liston C, Gunning FM, Wager TD. Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023 Sep 5;6(9):e2333846.

  • Ryan PC, Lowry NJ, Boudreaux E, Snyder DJ, Claassen CA, Harrington CJ, Jobes DA, Bridge JA, Pao M, Horowitz LM. Chronic Pain, Hopelessness, and Suicide Risk Among Adult Medical Inpatients. J Acad Consult Liaison Psychiatry. 2024 Mar-Apr;65(2):126-135. doi: 10.1016/j.jaclp.2023.11.686. Epub 2023 Nov 27. PMID: 38030078.

  • Watson JA, Ryan CG, Cooper L, Ellington D, Whittle R, Lavender M, et al. Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. J Pain. 2019 Oct;20(10):1140.e1–1140.e22.

  • Topol EJ, Bousser MG, Fox KAA, Creager MA, Despres JP, Easton JD, et al. Rimonabant for prevention of cardiovascular events (CRESCENDO): a randomised, multicentre, placebo-controlled trial. Lancet. 2010 Aug 14;376(9740):517–23.

  • Salazar-Méndez J, Cuyul-Vásquez I, Ponce-Fuentes F, Guzmán-Muñoz E, Núñez-Cortés R, Huysmans E, et al. Pain neuroscience education for patients with chronic pain: A scoping review from teaching-learning strategies, educational level, and cultural perspective. Patient Educ Couns. 2024 Jun;123:108201.

  • Czernichow S, Batty GD. Withdrawal of sibutramine for weight loss: where does this leave clinicians? Obes Facts. 2010 Jun;3(3):155–6.

  • Calverley PMA, Rabe KF, Goehring UM, Kristiansen S, Fabbri LM, Martinez FJ, et al. Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomised clinical trials. Lancet. 2009 Aug 29;374(9691):685–94.

  • National Institute of Mental Health (NIMH) [Internet]. [cited 2024 May 24]. Ask Suicide-Screening Questions (ASQ) Toolkit. Available from: https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials

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Ep 12. What Else Do You Say?

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Ep 10. History of Hysteria