Pain in People Experiencing Homelessness: A Scoping Review

Background Prior work suggests that people experiencing homelessness (PEH) are at heightened risk for developing pain and have a uniquely burdensome pain experience. Purpose The aim of this scoping review was to map the current peer-reviewed, published literature on the pain experience of PEH. Methods In accordance with the US Annual Homeless Assessment Report, we defined homelessness as lacking shelter or a fixed address within the last year. We conceptualized the pain experience via a modified version of the Social Communication Model of Pain, which considers patient, provider, and contextual factors. Published articles were identified with CINHAL, Embase, PubMed, PsycINFO, and Web of Science databases. Results Sixty-nine studies met inclusion criteria. Studies revealed that PEH have high rates of pain and experience high levels of pain intensity and interference. Substantially fewer studies examined other factors relevant to the pain experience, such as self-management, treatment-seeking behaviors, and pain management within healthcare settings. Nonetheless, initial evidence suggests that pain is undermanaged in PEH. Conclusions Future research directions to understand pain and homelessness are discussed, including factors contributing to the under-management of pain. This scoping review may inform future work to develop interventions to address the specific pain care needs of PEH. Lay Summary People experiencing homelessness are at increased risk for developing pain and having an especially burdensome pain experience. This scoping review described the current literature on pain in people experiencing homelessness. We searched five databases and identified 69 articles of relevance. Studies revealed that people experiencing homelessness have high rates of pain and experience high levels of pain intensity and interference. Fewer studies examined other factors relevant to pain-such as self-management, treatment-seeking behaviors, and pain care within health settings-however, initial evidence does suggest that pain is undermanaged in people experiencing homelessness. This scoping review informs future research to better understand pain and homelessness, as well as future work to develop interventions to address the specific pain care needs of people experiencing homelessness.