Chronic pain among homeless persons: characteristics, treatment, and barriers to management.
Chronic pain among homeless persons: characteristics, treatment, and barriers to management.
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DOI：
10.1186/1471-2296-12-73
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发表时间：
2011-07-08
影响因子：
2.9
通讯作者：
MacDonald A
中科院分区：
文献类型：
--
作者：
Hwang SW;Wilkins E;Chambers C;Estrabillo E;Berends J;MacDonald A
关于无家可归者的慢性疼痛问题，可获得的信息很少。这项研究旨在描述在加拿大多伦多经历慢性疼痛的无家可归的单身成人收容所使用者的代表性样本中慢性疼痛的特征和治疗、疼痛管理的障碍、并发的医疗条件和物质使用。参与者在2007年9月至2008年2月期间在单身无家可归成年人收容所随机选择，并对慢性疼痛进行筛查，慢性疼痛的定义是身体疼痛持续3个月或接受3个月前开始≥的疼痛治疗。横断面调查获得了关于人口统计学特征、慢性疼痛的特征和治疗、疼痛管理的障碍、并发的医疗条件和药物使用的信息。只要有可能，参与者的医生也会接受采访。在152名经历慢性疼痛的无家可归者中，11人(8%)被归类为慢性疼痛I级(低残疾-低强度)，47人(32%)为II级(低残疾-高强度)，34人(23%)为III级(高残疾-中度受限)，54人(37%)为IV级(高度残疾-严重受限)。自我报告的疼痛控制最常见的障碍是庇护生活的压力，买不起处方药，以及糟糕的睡眠条件。参与者报告使用非处方药(48%)、街头药物(46%)、处方药(43%)和酒精(29%)来治疗他们的疼痛。在接受采访的61名医生中，只有51%的人表示治疗了患者的疼痛。医生报告的最常见的疼痛管理困难是，由于患者有药物滥用史，不愿开麻醉药，精神合并症，经常错过预约，以及难以让患者正确服药。为无家可归者提供医疗保健的临床医生应该筛查慢性疼痛，并与患者讨论有效疼痛管理的障碍。
Little information is available on the problem of chronic pain among homeless individuals. This study aimed to describe the characteristics of and treatments for chronic pain, barriers to pain management, concurrent medical conditions, and substance use among a representative sample of homeless single adult shelter users who experience chronic pain in Toronto, Canada. Participants were randomly selected at shelters for single homeless adults between September 2007 and February 2008 and screened for chronic pain, defined as having pain in the body for ≥ 3 months or receiving treatment for pain that started ≥ 3 months ago. Cross-sectional surveys obtained information on demographic characteristics, characteristics of and treatments for chronic pain, barriers to pain management, concurrent medical conditions, and substance use. Whenever possible, participants' physicians were also interviewed. Among 152 homeless participants who experienced chronic pain, 11 (8%) were classified as Chronic Pain Grade I (low disability-low intensity), 47 (32%) as Grade II (low disability-high intensity), 34 (23%) as Grade III (high disability-moderately limiting), and 54 (37%) as Grade IV (high disability-severely limiting). The most common self-reported barriers to pain management were stress of shelter life, inability to afford prescription medications, and poor sleeping conditions. Participants reported using over-the-counter medications (48%), street drugs (46%), prescribed medications (43%), and alcohol (29%) to treat their pain. Of the 61 interviewed physicians, only 51% reported treating the patient's pain. The most common physician-reported difficulties with pain management were reluctance to prescribe narcotics due to the patient's history of substance abuse, psychiatric comorbidities, frequently missed appointments, and difficulty getting the patient to take medications correctly. Clinicians who provide healthcare for homeless people should screen for chronic pain and discuss barriers to effective pain management with their patients.
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