Co-Occurring Trauma and Non-Suicidal Self-Injury Among People With Chronic Pain: A Systematic Review

Curr Pain Headache Rep. 2021 Nov 11;25(11):70. doi: 10.1007/s11916-021-00984-x.


Purpose of review: Trauma and posttraumatic stress are common among individuals with chronic pain and contribute to increased morbidity and impairment. Individuals with trauma and chronic pain may be prone to non-suicidal self-injury, a relatively common yet risky self-regulatory behavior. There is a dearth of research on the intersection of trauma, chronic pain, and non-suicidal self-injury (NSSI). We conducted a systematic review of the extant literature.

Recent findings: Five quantitative and eight case reports were identified. Only one quantitative study reported specifically on NSSI. Self-harm rates varied across studies, though appeared elevated among patients with chronic pain. Childhood trauma was linked to this co-occurrence. Causal links between trauma, NSSI, and pain are proposed, highlighting the need for a comprehensive theoretical model. We recommend assessing for childhood trauma when treating patients with chronic pain and querying regarding NSSI when patients present with indicators of NSSI risk and to treat or refer such patients to specialized treatment.

Keywords: Abuse; Central sensitization; NSSI; PTSD; Pain; Self-harm.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Chronic Pain* / epidemiology
  • Cross-Sectional Studies
  • Humans
  • Risk Factors
  • Self-Injurious Behavior* / complications
  • Self-Injurious Behavior* / epidemiology
  • Suicidal Ideation