Chronic Pain Among Homeless Persons with Mental Illness

• Published in: Pain medicine (Malden, Mass.) Mass.), 2017-12, Vol.18 (12), p.2280-2288
• Main Authors: Vogel, Marc, Frank, Anastasia, Choi, Fiona, Strehlau, Verena, Nikoo, Nooshin, Nikoo, Mohammadali, Hwang, Stephen W, Somers, Julian, Krausz, Michael R, Schütz, Christian G
• Format: Article
• Language: English
• Subjects: Activities of daily living; Adult; Anxiety; Canada; Chronic pain; Chronic Pain - complications; Chronic Pain - epidemiology; Cross-Sectional Studies; Female; Homeless people; Homeless Persons - psychology; Humans; Male; Mental depression; Mental disorders; Mental Disorders - complications; Mental Disorders - epidemiology; Middle Aged; Mood; Multivariate analysis; Pain; Post traumatic stress disorder; Prevalence; Public health; Sleep; Social interactions; Substance use
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnw324

Abstract Objective Chronic pain is an important public health issue. However, characteristics and needs of marginalized populations have received limited attention. Studies on prevalence and correlates of chronic pain among homeless persons are lacking. We assessed chronic pain among homeless persons with mental illness in the At Home/Chez Soi study. Design Cross-sectional data from a randomized controlled trial on homelessness and mental health. Setting Data collected between 2009 and 2013 in three Canadian cities. Subjects One thousand two hundred eighty-seven homeless persons with mental illness. Methods Data on chronic pain and utilization of prescribed and nonprescribed interventions was assessed using a chronic pain screening instrument. Mental illness was diagnosed with the Mini-International Neuropsychiatric Interview. Results Forty-three percent reported moderate to severe chronic pain, interfering with general daily activities (80%), sleep (78%), and social interactions (61%). Multivariate analysis indicated that increasing age and diagnoses of major depressive disorder, mood disorder with psychotic features, panic disorder, and post-traumatic stress disorder (PTSD) were independent predictors of chronic pain. Chronic pain was further associated with increased suicidality. Among participants reporting chronic pain, 64% had sought medical treatment and 56% treated pain with prescribed drugs, while 38% used illicit drugs for pain relief. Conclusions Chronic pain is very common among homeless persons with mental illness and affects activities of daily living. Clinicians treating this population should be aware of the common connections between chronic pain, depression, panic disorder, PTSD, and substance use. While the data indicate the contribution of chronic pain to complex treatment needs, they also indicate a clear treatment gap.