Background & Aims

Individuals living in homelessness, already subjected to social invisibility and significant vulnerability, face a myriad of substantial obstacles on a daily basis. These challenges include high rates of chronic pain, a greater propensity for depression, and disturbances in sleep patterns. Despite these critical issues, research on this vulnerable group remains scarce, with few studies addressing these problems on a global scale. Thus, the present study aimed to determine the prevalence of chronic pain in the homeless population, identify the presence of depressive symptoms and sleep quality, and examine their relationships with pain. Additionally, the study analyzed the association between psychoactive substances and the presence of pain, identifying possible correlations.

Methods

This is a cross-sectional study that utilized a non-probabilistic sample of individuals experiencing homelessness in the city of São Luís/Brazil for at least one year, aged 18 and above, and without any cognitive deficits. Data were collected through interviews using sociodemographic questionnaires and the following scales: a) Visual Analog Scale (VAS) to measure pain intensity; b) Beck Scale version I to assess depression; c) Douleur Neuropathic 4 (DN4) questionnaire to identify chronic pain with neuropathic characteristics; and d) Mini-Sleep questionnaire used for screening sleep disorders.

Results

A contingent of 603 homeless individuals was included, with 90.4% being male, and an average age of 39.21 years. Of all interviewed individuals, 49.1% reported experiencing some type of pain, 42.1% were living with chronic pain, and 62.8% had pain with neuropathic characteristics. The data indicated a positive correlation between pain intensity (VAS) and other scores (DN4, Beck Scale, and Mini-Sleep), suggesting that as pain increases, there is a corresponding increase in neuropathic pain severity, the prevalence of depressive symptoms, and the deterioration of sleep quality. A statistically significant association was also identified between marijuana and alcohol consumption with depression (p<0.05), and alcohol consumption with sleep quality deterioration (p<0.001).

Conclusions

It can be concluded that the homeless population has a high prevalence of chronic pain, notably with neuropathic characteristics, along with an alarming rate of depression and impaired sleep quality, indicating a severe difficulty in sleeping. The intensity of pain is correlated with the presence of neuropathic characteristics, the development of depression, and the deterioration of sleep quality. Furthermore, depression has a statistically significant association with marijuana consumption and alcoholism, while sleep patterns are specifically influenced by alcohol consumption.

References

DE CAMPOS, Ariane Graça et al. Pain in Brazilian people experiencing homelessness. Pain Reports, v. 4, n. 6, 2019.

FISHER, Rebecca et al. The nature and prevalence of chronic pain in homeless persons: an observational study [version 1; referees: 2 approved]. 2013.

FRASER, Kristina A. et al. Perceptions of nonopioid treatment for pain in a homeless population. Journal of Osteopathic Medicine, v. 121, n. 7, p. 643-649, 2021.

GONZALEZ, Ariana; TYMINSKI, Quinn. Sleep deprivation in an American homeless population. Sleep health, v. 6, n. 4, p. 489-494, 2020.

HWANG, Stephen W. et al. Chronic pain among homeless persons: characteristics, treatment, and barriers to management. BMC Family Practice, v. 12, n. 1, p. 1-9, 2011

LÉGER, Damien; BECK, François; RICHARD, Jean Baptiste. Sleep loss in the homeless—an additional factor of precariousness: Survey in a group of homeless people. JAMA Internal Medicine, v. 177, n. 2, p. 278-279, 2017.

LÉPINE, Jean?Pierre; BRILEY, Mike. The epidemiology of pain in depression. Human Psychopharmacology: Clinical and Experimental, v. 19, n. S1, p. S3-S7, 2004.

MATTER, Rebecca et al. Measuring pain in the context of homelessness. Quality of Life Research, v. 18, p. 863-872, 2009.

RINTOUL, Kathryn et al. A scoping review of psychiatric conditions associated with chronic pain in the homeless and marginally housed population. Frontiers in Pain Research, v. 4, p. 1020038, 2023.

Presenting Author

João Batista Santos Garcia

Poster Authors

Natália Tavares BRAGA

post graduate

Federal Univesity of Maranhão

Lead Author

Lucas Soares BRITO

University Federal of Maranhão

Lead Author

Ana Carolina Silva ROCHA

University Federal of Maranhão

Lead Author

Mikaele Nala Costa dos SANTOS

University Federal of Maranhão

Lead Author

Joao Batista Garcia

Federal University of Maranhao

Lead Author

Topics

  • Lifestyle Issues: Sleep/Diet/Exercise/Social Interactions