• John Kowal, Keith G Wilson, Peter R Henderson, and Lachlan A McWilliams.
• *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.
• Clin J Pain. 2014 Jun 1; 30 (6): 463-71.

ObjectivesTo examine suicidal ideation (SI) in individuals with chronic pain, especially change in suicidal thinking after interdisciplinary treatment.Materials And MethodsConsecutive 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.ResultsBefore 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.DiscussionSI 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.

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