Pain and deliberate self-harm: an important association.
Theodoulou M., Harriss L., Hawton K., Bass C.
OBJECTIVE: The aim of this study was to establish how often pain was a factor contributing to an episode of deliberate self-harm. METHOD: Retrospective case note examination of all deliberate self-harm patients with concurrent medical problems admitted to a general hospital over 2 years. RESULTS: Pain was considered to be a contributory factor in the episode of deliberate self-harm in 75 (4%) of the total number of episodes of deliberate self-harm (1665) over the 2-year period. These patients were older and had higher suicide intent scores, but lower rates of previous psychiatric illness or alcohol or drug misuse than did the deliberate self-harm patients with medical problems but no pain. Although 60% had experienced pain for more than 6 months only, 8 (12%) were attending the local Pain Clinic at the time of the deliberate self-harm. CONCLUSION: We propose closer collaboration between general hospital services and local pain clinics for deliberate self-harm patients with painful disorders. Clinicians need to assess suicidal ideation and risk of self-harm when prescribing for this population.