Selfish

This is a reprint of a post I made for Migraine Checked about suicide. Since this is the anniversary of my second suicide attempt. Unmanaged pain is a very dangerous thing.

 

I want to talk about the very serious topic of suicidal ideation and suicide. The stigma with suicide though still runs rampant though and while I have seen so many people understand this death and so many others were caused by depression… others feel they can judge those who die in this way. They say they are selfish. That they should have just got help before it got that serious. That they should not have let their families suffer for their pain. I have seen this on twitter and I have seen it on Facebook. I have seen it recently and I have seen it before and I will see it again. “Suicide does not take the pain away, it gives it to someone else.” And people think these things because they do not understand depression. And because they do not understand suicide. And they do not even understand the two do not necessarily have to go together. Physical pain alone is a trigger for suicide.

This is one thing I want people to understand about suicide:

 

I am gone quite mad from the knowledge of accepting the overwhelming number of things I can never know, places I can never go, and people I can never be..png

In my case my suicide attempt in 2010 was not this spontaneous occurrence. With profound pain came suicidal ideation that I fought off every time. Bravo me. I survived more times than you can count. Was that then selfless of me or just survival instincts? We want to live. We love people. But there was a war within me and one I was losing.

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There is a thought process that we go through during these times. My existence was torture and it seemed Unreasonable that I should have to exist this way. Irrational that I would choose to exist in that pain and in fact choose to make it worse. Why would any sane person do that? And all avenues I had tried to reduce that pain had been used up. Society, my employer and my doctor at the time were all by their lack of caring and disinterest stating they wanted me to suffer. So this was my existence. Forever. And forever is a long time when you are in pain. A very long time. You see how endless and indefinite it is. If you just knew how long it was you had to go on. You begin to think how nice it would be to have a fatal stroke because… that would not be your fault. Then you imagine if you could kill yourself but make it look like an accident then no one would have to suffer with the knowledge that you had killed yourself. Clearly, I knew I was suicidal but these were Bad Days with Bad Thoughts. And my bad pain days were usually status migraine stretches, so I just had to wait them out… until I could get back to normal pain days. Normal hell. Then my work place would give me these ultimatums. If you do not work every day… we will do something unpleasant. And that would cause more pain, more stress, more suffering. Until that last ultimatum in that last status migraine…

Do not ever tell me someone is selfish when they are suicidal until you have been in that mental space. Until you have gone down that slippery slope of thinking and reached that line… and crossed it. You have no idea what goes on in that space. No clue. We do think of the consequences of our actions. It is just that first, we understand that grief will end and our suffering has no end unless we make it end. That is the first misconception our brain convinces us of. Well with physical pain we are very aware there literally is no end. But pain has a way of consuming your capacity to see reason as well, but that is another rant. (I will just say extreme pain warps reality as well) Second, that our families will be better off without us. We are a burden after all. We are holding them back. Imagine how much different and better their lives will be if we removed ourselves? Of course they would not Want that… but if we did it for them, it would in fact be better after they grieved for us. I myself was sure of this. I also knew my insurance company covered suicide so I knew financially some of my expenses would be covered… an added bonus really. Frankly, I assumed my existence was really rather worthless. Just this endless mass of pain that has no real meaning and worth. Except essentially to torment me… and That seemed like the ultimate madness really. You can rationalize suicide. You can slide down that slippery slope until you have essentially made it make Perfect Sense. I even explained it to a therapist after the fact and she could not even argue against me… as in she could not explain to me how my reasoning was not rational. She should have been able to because there should be flaws in the reasoning but we can really have quite an in-depth rational going on.

And so, no point arguing is there? There are finding reasons to live I find. Finding ways to live. Finding what you need to change and figuring out how to do it. Living until living works for you. Seeing a psychologist is something I chose to do to help with pain management because pain management is what I was severely lacking in. And it was damned hard. I was traumatized by the suicide attempt. I think sometimes people think an attempt is just a cry for attention but in fact it is just… didn’t get it right for whatever reason. In my case poor timing on my part. I know I could have had good timing and not be here right now because I had done the rest of it quite well. But I will say… it should be taken very seriously and the cause taken very seriously and the treatment taken very seriously. In my case it wasn’t really. The pain wasn’t treated. The work situation remained. And I became depressed from it. But after that… when I shook free from that I was motivated to change my doctor, see the psychologist, start managing my pain in new ways and took a long leave from work. I suspect I might not be here if I had not made those changes. Pain like that when not treated can really consume a person.

In the end when you survive a suicide attempt you are always at risk for another attempt. There is less of a chance of survival with a second attempt. We have to make that choice to understand the future does not mean endless suffering. The future can bring with it positive changes if we look for the right solutions and get the right sort of help that we need. It is not always easy to find and it is not always an easy solution… sometimes it is a damn hard fight, a constant endless battle to manage our suffering… but better than it would be with no help at all. With no hope at all.

We need to talk about this. We need to reduce the stigma of mental illness. And reduce the stigma of suicide. Check out: Stop calling suicide victims ‘selfish’

 

Suicide Hotlines

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Migraines and suicide #MHAM #CDNmigraine

Suicide attempts are 3 times more likely in people with #Migraine with aura. #MHAM

Suicide attempts are 3 times more likely in people with #Migraine with aura. #MHAM

 

Pain itself is a suicide risk factor. Suicidal ideation and intent can happen when pain exceeds our coping strategies. Which happens when we have no pain management and we are exceeding our pain limits.

During the 2-year followup period, persons with migraine or severe headache were at least 4 times more likely to attempt suicide than controls. The odds ratio in migraineurs — adjusted for sex, psychiatric disorder, and previous history of suicide attempt at baseline — was 4.43 (95% Confidence Interval [CI] 1.93, 10.2). Persons with non-migraine headache of comparable intensity and disability also had a greatly increased likelihood of suicide attempt as compared with controls: odds ratio, adjusted for the same covariates, was 6.20 (95% CI 2.40, 16.0). [Due to the wide, overlapping CIs the difference between the 2 odds ratio estimates was not statistically significant.]
Continue reading “Migraines and suicide #MHAM #CDNmigraine”

Pain epidemic #PainMatters

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We hear the media frenzy of the so called opiate epidemic, which seems to me to be people buying to on the street and less people getting it actually prescribed to them. And certainly little to do with chronic pain patients. But we never hear about the pain epidemic. And the lack of pain management.

The fact doctors are less trained in pain than your local veterinarian. Maybe pain patients should go to the vet instead? Or how about pain clinics. How many get to even see one? How many years does it take to get a referral to one? I was diagnosed with migraine and FM when I was 20, had hypermobility syndrome already by then… and when to a pain clinic when I was 38. Tried to kill myself from pain when I was 32. That should tell you a little about the lack of pain management I had going on then. Hopefully the average is sooner than 18 years.

What sort of treatment do they even get there? Are they getting to see a pain psychologist, taking a course in pain, learning to meditate, learning the exercises they need to do, having their medications assessed, being put on medications to help them have a quality of life, having them discuss their work situation and what improvements or changes need to be made their, any physio or other procedures to help with their treatment?

If you take away opiates because your all riled up about it for no reason… what will you replace it with so that pain patient has the same quality of life. Understanding that if you decrease their quality of life substantially you run the risk they will have suicidal ideation and/or intent. Doctors should be aware pain alone is a suicide factor. If they are not, here I am to tell you. Pain. Alone. Is a. Suicide. Factor.

It certainly was for me. I am on tramadol slow release twice a day. Before I went to the pain clinic I lived a different life. It was an existence of crawling through the pain every day. It has a raw desperate edge to it all the time. I was always pushing through the pain, exceeding my pain limits. In survival mode. Get through it. Get home. I was a hermit. Nothing left in me to leave the house. To socialize or do anything. I had a great deal of suicidal ideation. Wished I would die of a stroke or heart attack. I’d get chest pains from triptans that were nasty but never went to the ER… as I rather thought if they killed me it would be a natural death and that was better than by my hand. Finally a suicide attempt.

I never want to be in that place again with no managed pain. It is a hell I still think of. No one should have to endure that. No one should be shamed for opiates being part of their pain management.  Doctors should not be intimidated for using that tool when it is appropriate. And doctors should know pain matters. Our pain matters. Our lives matter. Our treatment matters.

Migraine Awareness 5: #MHAM #CDNmigraine

#Migraine can and does kill through stroke and suicide. #MHAM

migraineurmutteringsandmusings.com

Patients with migraine with aura had a greater than 2-fold increased risk for ischemic stroke compared with patients with migraine without aura (unadjusted odds ratio [OR], 2.4; 95% confidence interval [CI], 1.6 – 3.6; P < .0001). The results held up after adjustment for stroke risk factors.

Migraine with aura had a stronger association with cardioembolic stroke (OR, 3.3; 95% CI, 1.4 – 8; P = .009) than with thrombotic stroke (OR, 2.0; 95% CI, 1.2 – 3.4; P = .01). No significant association was observed between migraine with aura and lacunar stroke.Medscape

I had a suspected stroke myself, but with no evidence it is hard to say whether that neuros speculation was right or not since I didn’t go to the ER. I stopped going to the ER for status migraines a long time ago due to their incompetence, lack of knowledge and lack of treatment. Anyway, I had a status migraine and into it I woke up with half my hand numb. This numbness spread over my entire hand. It is peripheral neuropathy but the neuro speculates I had a stroke of some sort in my sleep. I personally don’t believe so because when the nerve damage was spreading over the hand, it started on the other hand although not as severely. Whatever process started it, it doesn’t sound like a stoke. Nevertheless my Other neuro believes the status migraine caused the nerve damage because they were common when I was working full time (status migraines) and that one in particular had persisted for a bit. Stroke risk is a worry and in particular status migraines are dangerous. Things neuros, doctors and ourselves have to be aware of. I know my doctor and I have had conversations about menstrual migraines and hormonal treatment… and no estrogen based birth control for me but we did try the depo shot for a bit. My neuro also has me trying to quit smoking, not because any speculation it might help with the migraines which he doesn’t believe, but simply because of my stroke risk factors.

It is important to be conscious of stroke symptoms when we have migraines. Be aware of what they are. It seems tricky sometimes with our auras. I have some insane auras that have freaked me out sometimes. And some silent migraines that freaked me out even more to be honest.

Stoke symptoms:

  • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking, or difficulty understanding speech.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
  • Sudden severe headache with no known cause.

None of these would alarms me in the least by the way. So I assume Unusual?

Acting F.A.S.T. Is Key for Stroke

Acting F.A.S.T. can help stroke patients get the treatments they desperately need. The most effective stroke treatments are only available if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for the most effective treatments if they don’t arrive at the hospital in time.

If you think someone may be having a stroke, act F.A.S.T.1 and do the following simple test:

F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms:
Ask the person to raise both arms. Does one arm drift downward?
S—Speech:
Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time:
If you observe any of these signs, call 9-1-1 immediately.

Note the time when any symptoms first appear. Some treatments for stroke only work if given in the first 3 hours after symptoms appear. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Treating a Transient Ischemic Attack

If your symptoms go away after a few minutes, you may have had a transient ischemic attack (TIA). Although brief, a TIA is a sign of a serious condition that will not go away without medical help. Tell your health care team about your symptoms right away.

Unfortunately, because TIAs clear up, many people ignore them. Don’t be one of those people. Paying attention to a TIA can save your life.CDC

Migraines and suicide 

Pain itself is a suicide risk factor. Suicidal ideation and intent can happen when pain exceeds our coping strategies. Which happens when we have no pain management and we are exceeding our pain limits.

I have had suicidal ideation. I have had suicide attempts. The main difference is that suicide ideation happens when pain levels are high, I get mood dips in the prodrome of the migraine and sleep issues like painsomnia. Even with pain management I have episodes of suicidal ideation although not as frequently as before. With suicide intent and attempts I had no pain management. I was exceeding my pain limits and coping strategies and there was no one there it help me with it. I had a completely disinterested doctor even when I explained I was having trouble coping with the pain. Doctors have little experience or training in pain management. I am stoic when in pain due to… well a very long history of pain. And then there is gender bias as well which I have experienced. I was constantly pushing through the pain. Crawling through existence. A life by inches. With a raw desperation I never want to experience again. Wasted years consumed by pain that it is astonishing I did live through to be honest.

The fact is it does kill. Pain kills. Lack of pain management kills. It is not something that is acknowledged these days but it is a fact. Treatment of chronic migraines is very difficult and not always an easy solution. I have had no luck with preventatives which complicates things. No answer with botox. How to live with the pain becomes a very difficult question with a very complex answer. All chronic pain has a higher suicide rate for this reason. Migraines though, we have something there that really kicks that in gear and it might very well be the mood issues in the prodrome that don’t help the issue at all. Certainly they have been the bane of my existence with extreme migraines. Doctors Need to pay attention to this risk factor. With chronic migraines we need pain management. I cannot stress the importance of a psychologist who specializes in pain as well.

During the 2-year followup period, persons with migraine or severe headache were at least 4 times more likely to attempt suicide than controls. The odds ratio in migraineurs — adjusted for sex, psychiatric disorder, and previous history of suicide attempt at baseline — was 4.43 (95% Confidence Interval [CI] 1.93, 10.2). Persons with non-migraine headache of comparable intensity and disability also had a greatly increased likelihood of suicide attempt as compared with controls: odds ratio, adjusted for the same covariates, was 6.20 (95% CI 2.40, 16.0). [Due to the wide, overlapping CIs the difference between the 2 odds ratio estimates was not statistically significant.]

The likelihood of suicide attempt was not influenced by alcohol- or drug-use disorder, or by migraine with or without aura. However, the average pain intensity score of persons who attempted suicide during the follow-up period was significantly higher than in persons who did not attempt suicide: mean 7.58 (Standard Deviation [SD] = 2.75) on a 0-to-10 scale compared with 5.18 (SD = 3.70), respectively. Essentially, the risk of suicide attempt increased by 17% with each 1 point rise on the pain-intensity scale; or, in other terms, an increase in pain score of 1 SD unit raised the odds of suicide-attempt by 79% (OR = 1.79).

The researchers conclude that their study provides strong confirmation of previous reports on the increased risk of suicide attempts associated with migraine and other headache of comparable severity and disability. Pain severity appears to be a most important etiological factor in this association — more so than co-occurring depression or anxiety disorder, or other factors; therefore, pain-relieving strategies may be of primary importance in these patients. Pain-topics

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Migraines, Fibromyalgia and suicide

There is a pain -so utter- It swallows substance up.

A recent study in Neurology has shown that people with comorbid fibromyalgia and migraines are at higher risk of suicide. Both conditions alone come with a higher risk of suicide as is. They found that people with comorbid FM and migraines experienced poorer sleep quality… which is hardly a surprise since one of the major FM symptoms is sleep dysfunction, but it also happens to be a migraine trigger. And this, in my personal experience, can be a viscous cycle. Sleep deprivation and status migraines certainly plummet my mood and have led to suicidal ideation and suicidal intent.

Migraines and FM are pretty comorbid with the with around 35% having FM and chronic migraines. Episodic it is a range of 12-31%.

In the study of 1,318 migraine patients, 10.1 % were found to also have comorbid FM. Of the migraine patients, 27.3 % reported suicidal ideation and 6.9 % reported suicide attempts and were higher in patients with comorbid FM than in those without; ideation: 58.3% and  attempt: 17.6%. With higher risk in the subgroups of migraine with aura, migraine without aura and chronic migraines.

To put that into perspective the rate of suicide in the world is 1.8% and the rate of suicide attempts is 2.7%. One study in Spain looking at FM patients found 16.7 % attempted suicide 1 to 3 times. A Demark study found suicide attempts in FM patients 10.5 times greater than the population average.

This is why unmanaged pain is a problem. And I should know, when my pain wasn’t managed I had a great deal of suicidal ideation and a suicide attempt. If anyone had asked me why, I would have said it was madness to continue an existence like that willingly. Forcing myself to work. Enduring that suffering. With a smile on my face. There is no valid reason to let someone suffer like that. None at all. And inevitable they will seriously consider ending their lives. I was in this survival mode of pain for more than a decade… how could it Not have occurred to me without proper treatment?

Pain should be taken very seriously. It doesn’t seem to be these days. And that concerns me a great deal. It is as if lives don’t matter. Quality of life doesn’t matter. The fact suicide occurs when Pain exceeds our capacity to Cope with it.

You add in chronic migraines with fibromyalgia… or complicate an already complicated pain situation with more pain and of course suicide risk factors increase. This is why pain treatment has to be managed carefully, looking at the entire person and addressing all issues. Coping, mood, the pain, work and family. And any other factor the patient sees as important for their care. It isn’t just medication. It is the strategies to deal with what the medication cannot treat, and it cannot treat that much of the pain to be honest.

 

Source

Spain Source

Denmark Source