Measuring Pain in the Context of Homelessness

The population of focus for this study is homeless individuals in the Seattle area who experience pain due to a chronic disease or disability (i.e. HIV, hepatitis, diabetes, neurological disorders, arthritis). Homeless people commonly experience pain and face multiple barriers to receiving accurate diagnosis and effective treatment for their pain (e.g., lack of health insurance, lack of access to specialty care, prevalence of mental health and substance abuse issues, disrespectful treatment by health care providers, and unstable, unsafe and uncomfortable living conditions). The failure of the health care system to provide appropriate and effective services to alleviate or manage pain can be a contributing factor to becoming and staying homeless.

One part of providing effective services is ensuring that tools used to measure pain are relevant to diverse and medically underserved populations – such as the homeless. This study aims to inform the development of more appropriate and relevant measure of pain for homeless individuals that can then be used in cl inical research and practice to facilitate an accurate diagnosis and treatment.

In this study, twenty homeless individuals were recruited through Seattle area shelters, transitional housing programs, and public agencies to participate in cognitive interviews to test validity and appropriateness of items used to measure pain. In addition to the cognitive interviews on pain measurement items, participants were asked a few open-ended questions about their experience seeking treatment for pain. Multiple items were identified as not relevant to homeless individuals, such as items that referenced “housework” or “recreational activities”. Other items were problematic due to lack of clarity, response scale difficulties, and problems with adhering to stated timeframe. Additional findings concerning the unique experience of homeless individuals with pain will be used to inform health care providers, advocates, and policy makers who are working to address the health care needs of homeless people with pain.