Suicide in Chronic Pain Patients
A few months ago, a special patient of mine decided that the pain in her body and life was too much and she ended her life. After taking care of patients with chronic pain of one type of another for more than 30 years, like many physicians who care for these patients, I have seen this before. It brings up a critical topic that’s very important to discuss openly but that often gets swept under the rug because it’s uncomfortable. What causes something like this to happen, and what can we do to prevent it?
My First Experience with a Patient Suicide
Ian was a young kid in his early twenties when his mother first brought him in to be treated for his chronic neck pain. By that time, he had already had one failed suicide attempt by trying to shoot himself in the head, but the gun shifted and, instead, he was left with half a twisted face. If you really want to explore your preconceptions around facial symmetry and how important it is to us humans, spend lots of time with someone who is in this awful place.
I was a young doctor then who knew far less than I know now about how to help patients with neck pain, and I had fewer tools to help patients, so while some things we did helped, some made no difference. I was left managing his narcotics, which were under the careful supervision of his mother. One night he wrote a note; took a handful of meds he had been siphoning from his daily, carefully metered supply; and decided to finish the job he started with the gun. His death haunted me for years.
My Most Recent Experience
I first met C online. I wasn’t really quite sure what to think, as this woman I didn’t know just began e-mailing me out of the blue. She had a UK-based e-mail address, so I figured she was British (turned out she was from the U.S.). While I field many random patient e-mails during any month, C was tenacious, like a patient pit bull. Over the months that followed, I must have gotten and answered 20 e-mails. She eventually revealed that she was a very active person who had gotten into the best shape of her life and then had gotten injured in a car crash. She was racking up huge debts getting care for her injuries. This is what she wrote on social media a year before I first saw her as a patient:
“This is all taking a tremendous toll on my mental health and on my marriage. All I want is the right to use my own stem cells!!!”
That last phrase is key to understand as C became a tireless advocate for patients who wanted the right to use their own stem cells. In fact, it was our battles to make that happen that I think got her so focused on our clinic.
Over that first year or two, she desperately wanted to get treated. That led to a phone review where I reviewed her MRIs. I have to say, at that point I was overwhelmed by the sheer number of problems she had and not optimistic I could help her. She had multiple bulging discs in her back and neck pressing on nerves and multiple areas of severe arthritis (she extensively shared these medical details online). She had been offered invasive surgeries to try and help these things, something she didn’t want. She seemed focused on wanting to be seen in the licensed Grand Cayman facility, but I felt platelet rich plasma based alternatives would be a better fit as a proof of concept that would be a fraction of the cost of culture-expanded stem cells. Since I knew C had limited resources, I discounted her care.
I have to say that the first time I was told by my office staff that she was in our Colorado office and waiting to be seen, I was a little concerned. First, I didn’t know if I could help. Second, anything we did would only make her financial situation worse. Third, what would all of that social media and online intensity and tenacity be like in the flesh? However, by the end of her first stay for treatment on her neck, back, knees, and multiple other joints, I got to know her as a person. She was a bit kooky, but also very passionate about helping others. So much so that she had formed her own nonprofit to help poor kids get through college, despite having few resources she could spare. She was someone who would give her last pair of good shoes away if someone else needed them more than she did.
C steadily got better, which was a bit of relief as I felt a tremendous responsibility for helping her at this point. She went from being mostly wheelchair bound because of pain to beginning to work out again, an amazing turnaround. I saw her one more time, the following year when she brought a disadvantaged college student from her nonprofit to show that impressionable young kid the cool stuff we were doing. I toured them both through our facility and our labs and walked this young woman through what I was doing in every procedure. And true to form, in fits and lurches, C improved. As a result, she also became a big advocate for what we were doing at Regenexx.
The Last Year
In the end, C had written me that traveling to Colorado was too difficult, so she would be working with a Regenexx affiliate closer to home. Hence, I didn’t have as much interaction with her this year. She had a new doctor, and I felt it best that I not get between her and her new physician. I now know from some of her many online friends that shortly before she took her life, she had injured herself exercising and was distraught that with her huge medical debt, incurred since her car crash, she would never be able to afford to keep the improvements she had made. I know her relationships were strained and that she felt that heavy weight of caring for others with few resources to continue to make that happen. I know she was distraught that the fight to allow patients unfettered access to their own stem cells wasn’t moving fast enough. When I heard online that she had passed, it hit me like a brick in the head. How did this happen? Why?
Suicide in Chronic Pain Patients
From speaking to colleagues, suicide is more frequent in chronic pain patients. For example, we know from research studies that patients with chronic arthritis pain are 50% more likely to commit suicide. If those patients have had a rough or awful childhood, those odds climb to several hundred percent higher. Other studies show the same link between chronic pain and suicide.
In addition, with our current insurance system, regardless of what patients choose to do, whether it be the multiple-level spine fusions C was offered or extensive PT, it all costs money out of pocket. In fact the patient expense burden continues to explode. A recent Kaiser Foundation study showed that the financial burden on patients is now rising seven times faster than workers’ earnings. So even if patients stay away from medical options, like regenerative medicine, that are out of pocket, the financial exposure of being sick in 2016 is high. Research has also linked financial and relationship stress as key factors in suicide risk.
The upshot? Patient suicides haunt doctors. In C, the world lost a wonderful woman who gave more than she had. While I was able to give her parts of her active life and hope back, in the end I couldn’t do enough to keep her with us. In fact, it’s that last bit that will haunt me for some time to come.