Chronic pain difficult to treat, hard to control, a threat for suicide

photo Studies say that the problem of managing chronic pain is connected with at least 10 percent of suicides, perhaps up to 70 percent.

FAST FACTS• Weather can affect pain. Changes in barometric pressure can cause an increase in pain, especially in those with arthritis.• Losing weight can ease pain. Less weight means less pressure which means less pain on joints and the back.• Exercise lessens painful flare-ups. Exercise can make muscles stronger, loosen stiff joints and help with coordination and balance. Start with low-impact exercises such as walking, swimming and stretching.• Attitude is important. Dwelling on your pain can make it feel worse.• Painkillers are not a sin. Taken as directed, prescriptions rarely become addictive.• Chronic pain is not part of getting older. Some aches and pains are normal with aging, but chronic pain is not.Source:

Aaron Coulter never set out to take his life during his partying phase in college, but he figured if it happened it happened.

Already taking pain pills for his neurofibromatosis, type 2, a rare genetic condition in which nerve tissue grows tumors, he decided that, if the pharmaceuticals mixed with the alcohol he was drinking and he just never woke up, "I just [didn't] care."

"Thankfully," says Coulter, now 24, "that was never the case, but passively I contemplated it."

The Dalton, Ga., resident is one of many people today who live with chronic pain and ponder suicide. According to several large-scale studies, at least 10 percent of suicides -- and maybe as many as 70 percent -- are linked to chronic pain or unrelenting illness.

"It's one of the most common medical problems in the world, especially in the United States," says Dr. Rett Blake of Chattanooga's Specialists in Pain Management. "There are many different causes, many different sources. And it's often very, very difficult to treat.

"Even with different surgeries, you can heal partially but not always heal completely from it."

Authors of a 2011 British study concluded that patients with such conditions "should be considered a high-risk group for suicide ... and much greater attention should be given to providing better ... psychological support."

Blake's not surprised at the numbers linking chronic pain and suicide.

"A lot of people deal with very severe pain," he says, "pain you wouldn't wish on your worst enemy. If untreated, you can see how it can lead to having those kinds of [suicidal] thoughts."

Gary Paul, executive director of Contact of Chattanooga, a 24-hour crisis line, says nearly 10 percent of the agency's calls in 2012 dealt with chronic health issues. Many people with a long-term illness develop depression, he says, and that works against the healing process.

"It's almost like a vicious circle," Paul says. "It just snowballs."

Further, he says, many of the people are being treated by a doctor but still can't get any relief. The worse the pain, the less they get around and the more likely they are to become shut-ins.

"For me," says Coulter, "the idea for suicide is you want some sense of control. Even if it's just the way I go out, I'm in charge. The big part is I don't want to deal with the pain."

Suicide, he says, is a way of controlling the pain.

Elizabeth Prestwood, a resident of Orlando, Fla., who lived most of her life in Chattanooga, has fibromyalgia, bipolar depressive disorder, degenerative joint and disc disease and has had three major back surgeries.

"Living with chronic pain syndrome and having to deal with other stressors makes it extremely hard," she says in an email, "as pain alone makes a person not able to focus, comprehend, nor do other things."

Often, says Prestwood, 43, it's not easy for people like her to discuss their condition with others because they appear fine on the outside. On the inside, she says, "they are mentally, physically and emotionally exhausted."

Prior to being diagnosed with fibromyalgia or having any of her back surgeries, Prestwood attempted suicide "more than once."

"I was just suffering from the depression," she says. "I often thought it would be easier for myself and others that were in my life."

Blake says there is a maxim that pain causes depression and depression causes pain.

"It's not a matter of which one came first," he says. "You have to treat both of those. That's why we have a psychologist in the office."

Eventually, Prestwood says, "I worked my way through the obstacles, trials, and hard times and realized that suicide was not the answer.

"I turned to God and prayed that I was tired of fighting with this disorder," she says. "I was tired of having others always be on caution for me, but if there was a reason I [was] to be in this life, then please show me. So together with God's help, I came off all the psychiatric medications, continued my therapy and made the determination to change my life."

Coulter, whose disorder is caused by a genetic mutation, says he gave up the idea of suicide when "one of my very best friends," John Bruner, collapsed as he neared the end of the 2007 Missionary Ridge Road Race and later died.

Although the death initially "pushed me closer to the edge in a lot of respects," the devastation of Bruner's death on his parents, family and friends convinced him "then and there that, if I took my life, I would be causing the same thing. I didn't want to do that to my family, his family. I had never seen that devastation before."

Both Prestwood and Coulter believe they now have wisdom they can impart to other people about living with chronic pain.

"There are days I would love to throw my hands up and say, 'I give up,'" says Prestwood, a wife, mother, photographer and full-time college student, "and the pain can be harder to bare than childbirth itself. However, I know there's a reason for me to be here today. I don't think about death or suicide because I realize that, if I can help just one person, then that's my reason. If I can show one person that their life is worth living, then I've helped someone."

Coulter, who has had 14 major operations related to his neurofibromatosis, is on disability but is writing a book about his journey.

"People have had it rougher," he said. "I'm here today because of the connections I have with my friends and my family."

Blake says doctors must balance the one in four people who lives with severe, chronic pain and the overprescription of medication that creates its own set of problems.

"Chronic pain is very, very common," he says. "It's still vastly untreated. But we have a [general] problem, and we're working toward curbing some of those problems. But for the patients who do live in pain, it's important to treat it the best we can."

McClatchy Tribune News Service contributed to this story.

Contact staff writer Clint Cooper at or 423-757-6497. Subscribe to my posts online at

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