This review shows that chronic pain is not only a symptom burden, but a clinically important suicide-risk context shaped by depression, sleep disturbance, mental defeat, catastrophizing, opioid transitions, and functional loss. The full read is worth it because it maps exactly which pain populations and care settings carry the strongest signal, where the evidence is most consistent, and which modifiable targets may help move suicide prevention in pain care from intuition to strategy.
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Abstract: This scoping review aims to synthesize current evidence regarding the association between chronic pain and suicide risk across diverse populations, identify key psychological and clinical predictors, and explore the mediating roles of mental health disorders and interpersonal factors. The review utilises 239 original studies with 4265434 total participants (topic deduplicated ΣN). This scoping review maps a consistent signal that chronic pain is associated with elevated suicidality, including a 2.29-fold higher odds of screening positive for suicide risk in medical inpatients and a 2.00-fold higher risk of death by suicide in genomic analyses. Across the evidence base, the most recurrent amplifiers were depression and other psychiatric comorbidity, mental defeat, perceived burdensomeness, sleep disturbance, pain catastrophizing, and functional impairment, while overdose-related outcomes and opioid tapering or discontinuation emerged as particularly important clinical contexts. The mapped literature also suggests that risk is not uniform: it appears especially salient in veterans, adolescents, older adults, and selected pain phenotypes such as fibromyalgia and chronic headache, and some care processes such as nonpharmacological treatment, exercise exposure, empathy, and acceptance-based approaches may be protective. Clinically, these findings support routine suicide screening in pain care and closer monitoring during periods of psychiatric worsening, sleep disruption, escalating pain burden, or opioid regimen change. Because much of the evidence remains heterogeneous and observational, the next priority is longitudinal and interventional research that tests whether targeting modifiable pathways such as depression, insomnia, catastrophizing, burdensomeness, and mental defeat can reduce suicidal ideation and suicidal behavior in chronic pain populations.
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Final search date and database lock: 2026-04-04 17:38:56 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 572
Downloaded Abstracts/Papers: 572
Included original and non-original Abstracts/Papers (all): 298
Included original Abstracts/Papers (Vote counting by direction of effect): 239
Reference Index (links used in paper): 115
Total participants (topic deduplicated ΣN): 4265434
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