Addressing Chronic Pain and Suicide - White River Junction VA Medical Center, Vermont
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White River Junction VA Medical Center, Vermont


Addressing Chronic Pain and Suicide

Dr. Lisham Ashrafioun

Dr. Lisham Ashrafioun from the VA Center of Excellence for Suicide Prevention at the VA Finger Lakes Healthcare System in Canandaigua, NY speaking at White River Junction VA Medical Center on the chronic pain cycle.

By Katherine Tang, Public Affairs Officer
Tuesday, October 8, 2019
During the month of September, the Department of Veterans Affairs (VA) aimed to bring awareness to suicide prevention and how everyone can help play a role in saving lives. At the White River Junction VA Medical Center, Dr. Lisham Ashrafioun addressed an audience of over fifty attendees, both clinical and non-clinical, on the relationship between pain and suicide.

Dr. Ashrafioun traveled to Vermont from the VA Center of Excellence for Suicide Prevention at the VA Finger Lakes Healthcare System in Canandaigua, NY to speak about chronic pain and suicide. In order to fully address pain, it must be fully understood. Oftentimes, the focus of pain treatment has been on the physical and biological aspects. However, the experience of pain is also impacted by psychological and social factors.

“Pain is not a simple sensory concern.” Explained Dr. Ashrafioun, “There is an emotional component to it.”

Over six-months’ time, if pain is experienced for at least half of that it is considered chronic pain. When addressing chronic pain, it is important to understand the biopsychosocial model which stresses the relationship among biological, psychological and the social factors.

As someone with pain disengages from their environment and becomes more inactive it can lead to depression and a feeling of hopelessness or self-defeat, leaving them vulnerable to suicide. Chronic pain is also associated with other disorders such as insomnia and chronic obstructive pulmonary disease (COPD), these too can exacerbate mental health disorders like anxiety and depression which may also increase vulnerability to suicide. Self-management strategies, including exercising, ensuring good sleep hygiene, or concentrating on engaging in enjoyable activities (community service, recreational activities, participating in the arts, etc.), may be useful first steps to reduce pain. For others, more intensive treatment may be needed. 

Chronic Pain Cycle

This figure is a depiction of the chronic pain cycle. A person’s chronic pain leads to deconditioning of their body and less activity overall. With less engagement in activity, a person may experience negative emotions such as depression, anxiety, and anger. These negative emotions may contribute to further avoidance of activities and withdrawal from other people thereby increasing distress and disability and continuing the cycle. As the chronic pain cycle continues, a person’s risk of suicide or factors associated with suicide may worsen.

Chronic pain can have a significant impact on their quality of life. If you encounter someone experiencing chronic pain it is important to ensure their concerns are heard. As a concerned friend, loved one or clinician it is important to listen and show empathy. Understanding the broader impact of one’s pain is critical in being able to better address it. Intervening to decrease pain catastrophizing (thinking the worst about your pain), maintain some level of physical activity, continue to engage in recreational activities, increase confidence that pain can be managed, and have some acceptance of pain may not only help manage pain, but can prevent the development of hopelessness or thoughts about suicide. Interventions including, but not limited to, cognitive-behavioral therapy for pain, physical therapy, and complementary and integrative health approaches like yoga or tai chi may be helpful. These interventions may improve functioning, while avoiding risks associated with opioid medications. With more severe pain that is having an even greater impact on psychosocial factors, engaging in specialty pain services, behavioral health, or substance use disorder services may be warranted. Suicide risk screening, suicide safety planning and referral to other evidence-based suicide prevention interventions may be needed for those at greater risk of suicide.

Here at White River Junction VA Medical Center we have an interdisciplinary approach to pain management. If a Veteran is experiencing pain, they will be seen by a physician that specializes in pain management and a mental health provider who will then refer the Veteran to try alternative treatments such as physical therapy, acupuncture, tai chi, yoga, etc. White River Junction VA Medical Center offers a Pain 101 class that introduces Veterans to the biopsychosocial model which creates a better understanding of their pain and how they can begin personalizing their paths to address it. This class also provides a peer support opportunity as it is done in a group setting. Finally, when the class is over the participants will have been introduced to mental health, physical therapy, recreation therapy, art therapy and more. It is important to treat the whole person not just the pain.

If you are a Service member or Veteran in crisis or you’re concerned about one, there are specially trained responders ready to help you, 24 hours a day, 7 days a week, 365 days a year. The Veterans Crisis Line connects Service members and Veterans in crisis, as well as their family members and friends, with qualified, caring VA responders through a confidential toll-free hotline, online chat, or text-messaging service.



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