title: Aggression, impulsivity, and suicide risk in benign chronic pain patients - a cross-sectional study.
abstract: OBJECTIVE
  The objective of this study was to investigate the role that psychopathological dimensions as overt aggression and impulsivity play in determining suicide risk in benign chronic pain patients (CPPs). Furthermore we investigated the possible protective/risk factors which promote these negative feelings, analyzing the relationship between CPPs and their caregivers.
  
  
  METHODS
  We enrolled a total of 208 patients, divided into CPPs and controls affected by internistic diseases. Assessment included collection of sociodemographic and health care data, pain characteristics, administration of visual analog scale (VAS), Modified Overt Aggression Scale (MOAS), Barratt Impulsiveness Scale Version 11 (BIS), Hamilton Depression Rating Scale (HDRS), and a caregiver self-administered questionnaire. All variables were statistically analyzed.
  
  
  RESULTS
  A significant difference of VAS, MOAS-total/verbal/auto-aggression, HDRS-total/suicide mean scores between the groups were found. BIS mean score was higher in CPPs misusing analgesics. In CPPs a correlation between MOAS-total/verbal/auto-aggression with BIS mean score, MOAS with HDRS-suicide mean score and BIS with HDRS-suicide mean scores were found. The MOAS and BIS mean scores were significantly higher when caregivers were not supportive.
  
  
  CONCLUSIONS
  In CPPs, aggression and impulsivity could increase the risk of suicide. Moreover, impulsivity, overt aggression and pain could be interrelated by a common biological core. Our study supports the importance of a multidisciplinary approach in the CPPs management and the necessity to supervise caregivers, which may become risk/protective factors for the development of feelings interfering with the treatment and rehabilitation of CPPs.
authors.affiliation: Psychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University Hospital of Bari, Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Margari
authors.affiliation: Department of Mental Health ASL BAT, Barletta, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Lorusso
authors.affiliation: Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University Hospital of Bari, Bari Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Matera
authors.affiliation: Psychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University Hospital of Bari, Bari, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Pastore
authors.affiliation: Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University Hospital of Bari, Bari Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Zagaria
authors.affiliation: Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplants, University Hospital of Bari, Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bruno
authors.affiliation: Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplants, University Hospital of Bari, Bari, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Puntillo
authors.affiliation: Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University Hospital of Bari, Bari Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Margari
keywords: chronic pain; impulsivity; overt aggression; suicide