Suicidality in patients with chronic noncancer pain and co-morbid substance use: A scoping review of the literature.

Individuals who suffer from chronic pain and those coping with substance use disorders (SUD) experience an elevated risk of suicide as compared to the general population. Less is known about the risk of suicide in patients with co-occurring chronic noncancer pain (CNCP), and substance use/or SUD. The objective of this scoping review was to characterize the literature on suicidality in persons with CNCP and comorbid substance use or SUD, identify themes and gaps in the literature, and propose future research initiatives. In this scoping review, 63 studies meeting the eligibility criteria were reviewed and results synthesized. A comprehensive search was conducted in Medline, Embase, PsycINFO, Scopus, and CINAHL. Studies were predominantly cross-sectional, community samples were underrepresented, and the majority of the studies were conducted in the United States. Several major themes within the literature emerged worthy of further exploration: 1) untreated/poorly managed pain; 2) negative affective processes; 3) social factors; 4) stigma; and 5) potential interventions. Major gaps in the literature included a paucity of standardized assessment of suicidality, limited use of rigorous study designs, and limited representativeness of the patient populations studied. PERSPECTIVE: This scoping review examined the literature on chronic pain, substance use, SUD and suicidality, identified major themes and gaps in knowledge, and reviewed opportunities for future research in this area.