Abstract Details

Title Effect of Opioid Use and Depressive Symptoms on Bodily Pain Severity in Adults Living in Precarious Housing or Homelessness: A Longitudinal Prospective Study

Topic Pain

Presentation(s) Pain and Palliative Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 009

Background

Pain is an important public health challenge, with limited understanding of pain risk factors and consequences among marginalized populations. Early studies have suggested cannabis use may be associated with less opioid use and improvement in pain severity.

Objective This study investigates the risk factors and consequences of pain in homeless or precariously housed adults over five years.

Design/Methods The Hotel Study is an ongoing 20-year naturalistic prospective study of adults living in precarious housing or homelessness in Vancouver, Canada. Bodily pain severity and impact (SF-36), risk factors, and functioning were assessed monthly. Mixed-effects linear regression models estimated the effects of risk factors for pain, verified by reverse causality and multiple imputation analysis. Linear regression models estimated the association between pain and real-world functioning and suicidal ideation.

Results

Participants (n=370) were 88% male, with median age 44. Bodily pain of at least moderate severity persisted (>3 months) in 64% of participants, with 25% reporting significant impact on daily activities. Over time, greater pain severity was associated with PTSD (estimate=-2.73, SE=1.14, p=0.02), arthritis (estimate=-5.62, SE=1.01, p<0.001), and greater depressive symptom severity in the past month (estimate=-0.26, SE=0.02, p<0.001). The frequency of prescribed (linear: estimate=-0.34, SE=0.06, p<0.001; quadratic: estimate=0.01, SE=0.002, p<0.001) and non-prescribed opioid use (linear: estimate=-0.16, SE=0.05, p<0.001; quadratic: estimate=0.004, SE=0.002, p=0.012) had non-linear relationships with pain, whereby intermittent use was associated with more severe pain. Cannabis use did not modify pain or the effect of opioid use on pain. Pain was associated with worse functioning (estimate=0.05, SE=0.02, p=0.002), unmet healthcare needs (OR=0.92, CI=0.89-0.95, p<0.001), and suicidal ideation (OR=0.95, CI=0.93-0.98, p<0.001).

Conclusions Chronic pain was common and impacted functioning and suicidal ideation. Cannabis use did not modify pain severity in this population. The relationships between chronic pain, intermittent opioid use, depression, PTSD, and mechanical injury are important to consider when caring for precariously housed populations.

Authors/Disclosures
Andrea Jones, MD, PhD (University of British Columbia) PRESENTER	Dr. Jones has nothing to disclose.
	No disclosure on file
	No disclosure on file
Thalia S. Field, MD (University of British Columbia)	Dr. Field has received personal compensation for serving as an employee of Springer. Dr. Field has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Canadian Medical Protective Association. The institution of Dr. Field has received research support from Bayer Canada.
	No disclosure on file
William Panenka, MD	Dr. Panenka has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file