The nature and prevalence of chronic pain in homeless persons: an observational study

Abstract

Background: Homeless people are known to suffer disproportionately with health problems that reduce physical functioning and quality of life, and shorten life expectancy. They suffer from a wide range of diseases that are known to be painful, but little information is available about the nature and prevalence of chronic pain in this vulnerable group. This study aimed to estimate the prevalence of chronic pain among homeless people, and to examine its location, effect on activities of daily living, and relationship with alcohol and drugs.

Methods: We conducted face-to-face interviews with users of homeless shelters in four major cities in the United Kingdom, in the winters of 2009-11. Participants completed the Brief Pain Inventory, Short Form McGill Pain questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs, and detailed their intake of prescribed and unprescribed medications and alcohol. We also recorded each participant's reasons for homelessness, and whether they slept rough or in shelters.

Findings: Of 168 shelter users approached, 150 (89.3%) participated: 93 participants (63%) reported experiencing pain lasting longer than three months; the mean duration of pain experienced was 82.2 months. The lower limbs were most frequently affected. Opioids appeared to afford a degree of analgesia for some, but whilst many reported symptoms suggestive of neuropathic pain, very few were taking anti-neuropathic drugs.

Interpretation: The prevalence of chronic pain in the homeless appears to be substantially higher than the general population, is poorly controlled, and adversely affects general activity, walking and sleeping. It is hard to discern whether chronic pain is a cause or effect of homelessness, or both. Pain is a symptom, but in this challenging group it might not always be possible to treat the underlying cause. Exploring the diagnosis and treatment of neuropathic pain may offer a means of improving the quality of these vulnerable people's lives.

Figure 1.. The distribution of pain reported by homeless shelter users.

Figure 2.. Pain intensity reported by homeless people categorised by drug use.

Scatter plot to show the severity of average pain reported by homeless people who either take prescribed opioids, non-prescribed opioids, or cannabis; or those who take over the counter non-opioid analgesics or no drugs. Bars indicate means. Data compared using Mann-Whitney test.

Figure 3.. Pain intensity reported by homeless people categorised by alcohol use.

A) Scatter plot showing the amount of alcohol consumed by homeless people reporting versus those who did not. Bars indicate means. B) Linear regression plot showing lack of relationship between quantity of alcohol consumed and intensity of pain reported. The unbroken line represents the best-fit slope and the broken lines the 95% confidence intervals (best-fit slope 0.579, 95% CI -0.06–2.24, r ²=0.034).