title: Psychological and physical pain as predictors of suicide risk: evidence from clinical and neuroimaging findings.
abstract: OBJECTIVE
  Suicide is a multidimensional clinical phenomenon with complex biological, social and psychological risk factors. Therefore, it is imperative for studies to focus on developing a unified understanding of suicide risk that integrates current clinical and neurobiological findings. A recent line of research has implicated different classifications of pain in understanding suicide risk, including the concepts of psychache and pain tolerance. Although psychache is defined as the experience of unbearable psychological pain, pain tolerance refers to the greatest duration or intensity of painful stimuli that one is able to bear. This review will focus on integrating current clinical and neurobiological findings by which psychache and pain tolerance confer suicide risk.
  
  
  RESULTS
  Results indicate that psychache has been identified as a significant risk factor for suicide and that psychache may be associated with the neurocircuitry involved in the modulation of physical pain. Converging evidence has also been found linking pain tolerance to self-injurious behaviours and suicide risk. The experience of psychache and physical pain in relation to other predictors of suicide, including reward processing, hopelessness and depression, are further discussed.
  
  
  CONCLUSIONS
  Future research examining the pain-suicide connection is required to understand the mechanism behind clinically relevant risk factors for suicide, which can ultimately inform the construction of empirically supported suicide risk assessment and intervention techniques.
authors.affiliation: aArthur Sommer Rotenberg Suicide and Depression Studies, St. Michael's Hospital bDepartment of Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Canada cINSERM U1061; La Colombière Hospital, University of Montpellier, Montpellier, France.
authors.forename: Sakina J
authors.initials: SJ
authors.lastname: Rizvi
authors.forename: Adam
authors.initials: A
authors.lastname: Iskric
authors.forename: Raffaella
authors.initials: R
authors.lastname: Calati
authors.forename: Philippe
authors.initials: P
authors.lastname: Courtet
mesh_terms: D001921:Brain / Q000503:physiopathology; D001931:Brain Mapping; D002605:Character; D059350:Chronic Pain / Q000503:physiopathology / Q000523:psychology*; D003863:Depression / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging; D001523:Mental Disorders / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D009415:Nerve Net / Q000503:physiopathology; D018847:Opioid Peptides / Q000502:physiology; D017288:Pain Threshold / Q000502:physiology; D018570:Risk Assessment; D016728:Self-Injurious Behavior / Q000503:physiopathology / Q000523:psychology; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology*; D013405:Suicide / Q000523:psychology*; D000092864:Suicide Prevention
chemical_list: D018847:Opioid Peptides