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Chronic pain patients are at elevated risk for suicide, but suicidality as an escape from persistent suffering is not the full picture. Chronic pain is comorbid with mental health conditions, in particular depression and personality disorders, which carries with it elevated risk for suicidality. The neural networks involved in chronic pain processing overlap those with depression. Affective disorders such as catastrophizing may not only exacerbate painful symptoms but also increase the risk of suicidal ideation independent of pain intensity and depression. Insomnia, likewise common in the chronic pain population, has also emerged as a risk factor for suicide. The use of certain drugs has also been linked to increased suicidality. Thus, an interplay of factors may enhance suicide risk in the chronic pain population. Migraine is more associated with suicidality than other disease conditions, while neuropathic pain seems to confer no additional risk of suicide. The role of cytokine imbalances and inflammatory processes is being explored as a risk factor for suicide in patients with chronic pain and/or mental health disorders. Substance abuse may also play a role in increasing the risk of suicide in chronic pain patients. The chronic pain population is a particularly vulnerable population with respect to suicidality and clinicians should be mindful of these risks in treating chronic pain patients. *Correspondence to: John Bisney, NEMA Research, Inc., 868 106th Ave North, Naples, FL 34108, USA, Tel: 979864 4479, E-mail: john@leqmedical.com

The risk of suicide in chronic pain patients