On the morning of April 12, Vicki McKenney called 911 from her home in Windham. Her 66-year-old husband was threatening to shoot and kill himself.

The dispatcher asked if he had dementia, according to a transcript of the call.

“No. No. He’s had chronic low back pain for seven months,” McKenney said. “Nobody’s helped him and it’s really affected him mentally.”

Although pain is a common medical complaint, when it seems as though it might never get better, it can be one of the most desperate conditions, leading patients to drastic measures. The sense of hopelessness was evident in the recent case of Stephen McKenney, the murder-suicide of an elderly couple in Gouldsboro last month and the experience of a 31-year-old Westbrook woman who is still alive to tell about it.

People suffering from chronic pain often feel helpless, hopeless and alone. Their quality of life has diminished; they can no longer do things that gave them joy.

When they don’t have a diagnosis, doctors might dismiss the pain as in their head or an excuse to get drugs. They may have to stop working and find it harder to be around friends, who don’t necessarily want to be with someone who’s in pain all the time. The pain becomes all they have to think about, which in turn can make it worse. It’s a cycle that may seem impossible to escape.

The risk of suicide in chronic pain patients is believed to be about twice as high as the general population, according to a 2011 pain report by the Institute of Medicine.

One study showed that people with chronic pain are more than twice as likely to have thought about suicide, more than three times as likely to have planned their suicide and more than six times as likely to have attempted suicide, the report said.

No one will ever know if Stephen McKenney was determined to end his life that day in April.

Minutes after his wife’s 911 call, a sheriff’s deputy showed up at the house and ordered him drop his gun. As McKenney walked down his driveway toward the police cruiser, the deputy fired two shots, the second of which killed him.

Vicki McKenney, who filed a notice of claim against the deputy, declined to talk in more detail about her husband’s pain issues.

The reason Ray Hutchins shot his 75-year-old wife, Ginger, in their Gouldsboro home on Thanksgiving Day will also remain a mystery. After killing her, Hutchins, 65, turned the gun on himself.

Friends and family members believe their health issues – particularly her painful and degenerative arthritis – had taken away their will to live. The day before they died, Ginger Hutchins went to the emergency room after falling. She had no visible injuries, but when a doctor asked her to rate her pain on a scale of 1 to 10, she said 12.

Nikki Gagnon can say firsthand what’s it’s like to have pain that brings you to the brink of suicide. She was there just over a year ago.

Gagnon, who grew up in Westbrook, started having pain in her feet when she was 9 years old. By 17, she could barely walk.

Over the years, she’s been diagnosed with tight heel cords, plantar fasciitis, cerebral palsy, multiple sclerosis and depression. She’s gotten surgery to lengthen her muscles, Lidocaine infusions, Botox injections, a spinal cord stimulator implanted in her back and psychotherapy.

It took all of her energy, but she managed to make it through college. She even studied abroad in Tanzania, using crutches, a wheelchair and a motorcycle to get around.

Now 31, Gagnon still doesn’t have an answer to what’s causing her pain. A couple of years ago, she resigned herself to the fact that she probably never would.

Bedridden, bored and fed up with the treatment she’d received from physicians – who were often dismissive because she had no diagnosis – Gagnon started coming up with her own plans for getting rid of the pain.

If she was paralyzed, she thought, it might go away. She read about a man who used dry ice to freeze his leg. She thought about doing that and asking her brother to chop it off, or shoot her in the back.

“I had a lot of desperate, sad, sad thoughts,” she said. “When you’re in that amount of pain, you feel like you would do anything.”

Reading online forums, however, she found out that people with paralysis can still have pain. That’s when she turned to suicide. She told her parents she didn’t think she could keep going.

“They were horrified, but they understood,” she said.

When she told doctors how she felt, they attributed her pain to her mental health – not the other way around. She cut down on her visits to doctors she felt weren’t helping her.

In August 2013, Gagnon decided she was done living. She wrote a suicide note and closed her Netflix account to give her parents one less thing to worry about.

“I just couldn’t take it anymore. The pain was just never-ending. I just thought, this is going to happen again tomorrow and the next day and the next day and what is going to change? Nothing,” she said.

Gagnon’s mother happened to come home early from work that day and went right to her daughter’s bedroom. She found Gagnon in tears and forced her to go to the emergency room.

Angry about how she’d been treated there before, she told doctors to just discharge her like they always do. She had been planning to kill herself and wanted to finish the job, she told them.

When they pegged her as a psychiatric patient, she demanded they treat her for her medical problem and, as a last-ditch effort, asked for an extended-release opiate she’d read about but never tried.

“I’m going to try this and if this doesn’t work, then that’s it,” she remembers thinking.

It helped.

“It didn’t solve all my problems, but it helped enough that I could get out of bed for a few hours every day.”

The same week, Gagnon, who had been accepted into a master’s program for social work at Simmons College in Boston, had to decide whether she was going to go. She did.

That was last fall. This summer, Gagnon came down with mononucleosis and decided to put off her second year. She’s back recovering at her parents’ house in Westbrook.

She’s still taking the same medication and it’s still making her feel better, but that’s happened before, then suddenly stopped working.

“I live in fear every day that it will all fall apart,” she said.