Chronic pain among homeless persons: characteristics, treatment, and barriers to management

Abstract

BackgroundLittle information is available on the problem of chronic pain among homeless individuals. This study aimed to describe the characteristics of and treatments for chronic pain, barriers to pain management, concurrent medical conditions, and substance use among a representative sample of homeless single adult shelter users who experience chronic pain in Toronto, Canada.MethodsParticipants were randomly selected at shelters for single homeless adults between September 2007 and February 2008 and screened for chronic pain, defined as having pain in the body for ≥ 3 months or receiving treatment for pain that started ≥ 3 months ago. Cross-sectional surveys obtained information on demographic characteristics, characteristics of and treatments for chronic pain, barriers to pain management, concurrent medical conditions, and substance use. Whenever possible, participants' physicians were also interviewed.ResultsAmong 152 homeless participants who experienced chronic pain, 11 (8%) were classified as Chronic Pain Grade I (low disability-low intensity), 47 (32%) as Grade II (low disability-high intensity), 34 (23%) as Grade III (high disability-moderately limiting), and 54 (37%) as Grade IV (high disability-severely limiting). The most common self-reported barriers to pain management were stress of shelter life, inability to afford prescription medications, and poor sleeping conditions. Participants reported using over-the-counter medications (48%), street drugs (46%), prescribed medications (43%), and alcohol (29%) to treat their pain. Of the 61 interviewed physicians, only 51% reported treating the patient's pain. The most common physician-reported difficulties with pain management were reluctance to prescribe narcotics due to the patient's history of substance abuse, psychiatric comorbidities, frequently missed appointments, and difficulty getting the patient to take medications correctly.ConclusionsClinicians who provide healthcare for homeless people should screen for chronic pain and discuss barriers to effective pain management with their patients.

Pain Treatment and Antiretroviral Medication Adherence Among Vulnerable HIV-Positive Patients

“…In this regard, prior research has linked housing instability to both high pain prevalence and multiple barriers to care. [28][29][30][31][32] Consistent with prior studies, [33][34][35] bivariate analyses found that pain endorsement was strongly associated with psychological distress among this sample of substance users. Individuals with pain, regardless of treatment status, exhibited higher symptom levels for both depression and anxiety, compared to the pain-free.…”

“…The relatively common selection of non-opioid medications may reflect caution among health care providers and prescribers treating a population with known substance abuse issues. 28 Among our vulnerable sample of socioeconomically disadvantaged HIV-positive substance users, pain likely arose from multiple sources, including aging, long-standing participation in street lifestyles that entail drug use and exposure to violence, the presence of multiple chronic health conditions, as well as poverty-driven limitations on health care access and basic subsistence needs. Our bivariate analyses demonstrated that food and housing insecurity were significantly associated with pain endorsement.…”

Factors Associated With Premature Exits From Supported Housing

“…The association between substance use disorders and exits builds on literature describing a dearth of Housing First outcome data for consumers with severe substance use disorders (14). Injection drug use is the strongest predictor of HCV (35), and substance use disorders are highly prevalent among homeless consumers with chronic pain (36). Associations between these diagnoses and exiters may reflect an underlying association with substance use disorders.…”

Niveaux et raisons du sans-abrisme chez les Francophones dans le nord de l’Ontario

“…Une nuit, on en a dénombré 5 000 à Toronto, 900 à Ottawa et 2 700 à Vancouver (Hwang, et collab., 2011). Globalement et sur une base annuelle, on estime que le nombre de sans-abri varie entre 150 000 et 300 000 au Canada (Hwang, et collab., 2011).…”

“…Une nuit, on en a dénombré 5 000 à Toronto, 900 à Ottawa et 2 700 à Vancouver (Hwang, et collab., 2011). Globalement et sur une base annuelle, on estime que le nombre de sans-abri varie entre 150 000 et 300 000 au Canada (Hwang, et collab., 2011). Le dénombrement des sans-abri au pays a commencé en 1987 via les travaux du Conseil canadien de développement social (Begin, et collab., 1999).…”