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Change in Suicidal Ideation After Interdisciplinary Treatment of Chronic Pain

Kowal, John PhD*,†,‡,§; Wilson, Keith G. PhD*,†,§,∥; Henderson, Peter R. PhD*,†; McWilliams, Lachlan A. PhD

The Clinical Journal of Pain: June 2014 - Volume 30 - Issue 6 - p 463–471
doi: 10.1097/AJP.0000000000000003
Original Articles

Objectives: To examine suicidal ideation (SI) in individuals with chronic pain, especially change in suicidal thinking after interdisciplinary treatment.

Materials and Methods: Consecutive patients (n=250) admitted to a 4-week, group-based chronic pain management program completed measures of pain intensity, functional limitations, depressive symptoms, overall distress, pain catastrophizing, self-perceived burden, and SI at pretreatment and posttreatment.

Results: Before treatment, 30 (12.0%) participants were classified as having a high level of SI, 56 (22.4%) had a low level of SI, and 164 (65.6%) reported none. After treatment, there was a significant reduction in SI and improvements in all other outcomes, but there were still some individuals with high (n=22, 8.8%) or low (n=28, 11.2%) levels at discharge. Patients with high SI at baseline differed from those with no suicidal thinking on pretreatment and posttreatment measures of depression, distress, catastrophizing, and self-perceived burden, but not on pain intensity or functional limitations. Patients high in SI endorsed greater pain catastrophizing and self-perceived burden than those low in suicidal thinking. Sustained SI after treatment was associated with higher baseline levels of suicidal thinking and self-perceived burden to others, as well as a more limited overall response to treatment.

Discussion: SI was common in individuals with chronic pain, although mostly at a low level. Interdisciplinary treatment may result in reduced suicidal thinking; however, some patients continue to express thoughts of self-harm. Future studies could examine processes of change and interventions for treatment-resistant suicidal concerns.

*Department of Psychology, The Ottawa Hospital Rehabilitation Centre

School of Psychology

Department of Anaesthesiology

Department of Medicine, University of Ottawa

§Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada

Supported by grants from the Canadian Institutes of Health Research, Ottawa, ON, Canada (MOP: 93645) and the Centre for Rehabilitation Research and Development of The Ottawa Hospital Rehabilitation Centre, Ottawa, ON, Canada. The authors declare no conflict of interest.

Reprints: John Kowal, PhD, Department of Psychology, The Ottawa Hospital Rehabilitation Centre, 505 Smyth Road, Ottawa, ON, Canada K1H 8M2 (e-mail:

Received March 25, 2013

Accepted August 1, 2013

© 2014 by Lippincott Williams & Wilkins