{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T15:53:08Z","timestamp":1790437988556,"version":"4.1.0"},"reference-count":35,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2013,7,30]],"date-time":"2013-07-30T00:00:00Z","timestamp":1375142400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Homeless people are known to suffer disproportionately with health problems that reduce physical functioning and quality of life, and shorten life expectancy. They suffer from a wide range of diseases that are known to be painful, but little information is available about the nature and prevalence of chronic pain in this vulnerable group. This study aimed to estimate the prevalence of chronic pain among homeless people, and to examine its location, effect on activities of daily living, and relationship with alcohol and drugs.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    We conducted face-to-face interviews with users of homeless shelters in four major cities in the United Kingdom, in the winters of 2009-11. Participants completed the Brief Pain Inventory, Short Form McGill Pain questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs, and detailed their intake of prescribed and unprescribed medications and alcohol. We also recorded each participant\u2019s reasons for homelessness, and whether they slept rough or in shelters.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Findings:<\/ns4:bold>\n                    Of 168 shelter users approached, 150 (89.3%) participated: 93 participants (63%) reported experiencing pain lasting longer than three months; the mean duration of pain experienced was 82.2 months. The lower limbs were most frequently affected. Opioids appeared to afford a degree of analgesia for some, but whilst many reported symptoms suggestive of neuropathic pain, very few were taking anti-neuropathic drugs.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Interpretation:<\/ns4:bold>\n                    The prevalence of chronic pain in the homeless appears to be substantially higher than the general population, is poorly controlled, and adversely affects general activity, walking and sleeping. It is hard to discern whether chronic pain is a cause or effect of homelessness, or both. Pain is a symptom, but in this challenging group it might not always be possible to treat the underlying cause. Exploring the diagnosis and treatment of neuropathic pain may offer a means of improving the quality of these vulnerable people\u2019s lives.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.2-164.v1","type":"journal-article","created":{"date-parts":[[2013,7,30]],"date-time":"2013-07-30T09:42:29Z","timestamp":1375177349000},"page":"164","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":33,"title":["The nature and prevalence of chronic pain in homeless persons: an observational study"],"prefix":"10.12688","volume":"2","author":[{"given":"Rebecca","family":"Fisher","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Ewing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Garrett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E Katherine","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly KT","family":"Lwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel W","family":"Wheeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2013,7,30]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"49-64","DOI":"10.1111\/j.1540-4560.1990.tb01798.x","article-title":"Poor people, poor health: the health status of the homeless.","volume":"46","author":"J Wright","year":"1990","journal-title":"J Soc Issues."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1136\/bmj.327.7406.81","article-title":"10 year follow up study of mortality among users of hostels for homeless people in Copenhagen.","volume":"327","author":"M Nordentoft","year":"2003","journal-title":"BMJ."},{"key":"ref-3","article-title":"Crisis: Homelessness policy watch: homelessness kills.","year":"2008"},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"2205-2214","DOI":"10.1016\/S0140-6736(11)60747-2","article-title":"Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study.","volume":"377","author":"S Nielsen","year":"2011","journal-title":"Lancet."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"1821-1825","DOI":"10.1111\/j.1360-0443.2008.02339.x","article-title":"The oral health of street-recruited injecting drug users: prevalence and correlates of problems.","volume":"103","author":"A Laslett","year":"2008","journal-title":"Addiction."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"2325-2330","DOI":"10.1001\/archinte.1990.00390220069014","article-title":"Health, homelessness, and poverty. A study of clinic users.","volume":"150","author":"L Gelberg","year":"1990","journal-title":"Arch Intern Med."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"785-788","DOI":"10.1001\/archinte.1991.00400040123029","article-title":"Immersion foot. A problem of the homeless in the 1990s.","volume":"151","author":"K Wrenn","year":"1991","journal-title":"Arch Intern Med."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"77-84","DOI":"10.1016\/S1473-3099(01)00062-7","article-title":"Infections in the homeless.","volume":"1","author":"D Raoult","year":"2001","journal-title":"Lancet Infect Dis."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"921-928","DOI":"10.1046\/j.1525-1497.2003.20909.x","article-title":"Health care for homeless women.","volume":"18","author":"J Lewis","year":"2003","journal-title":"J Gen Intern Med."},{"key":"ref-10","doi-asserted-by":"crossref","first-page":"36-41","DOI":"10.12968\/bjon.2010.19.1.45910","article-title":"A nurse-led response to unmet needs of homeless migrants in inner London.","volume":"19","author":"S Collinson","year":"2010","journal-title":"Br J Nurs."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"351-369","DOI":"10.2190\/FYAR-WEYE-M1T8-7MF3","article-title":"Risks associated with long-term homelessness among women: battery, rape, and HIV infection.","volume":"25","author":"B Fisher","year":"1995","journal-title":"Int J Health Serv."},{"key":"ref-12","article-title":"Housing Act United Kingdom legislation.","year":"1996"},{"key":"ref-13","article-title":"Statutory Homelessness: April to June Quarter 2012 England.","year":"2012"},{"key":"ref-14","article-title":"Rough Sleeping Statistics England - Autumn 2010 Experimental Statistics.","year":"2010"},{"key":"ref-15","first-page":"S1-226","article-title":"Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain Subcommittee on Taxonomy.","volume":"3","year":"1986","journal-title":"Pain Suppl."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"1248-1252","DOI":"10.1016\/S0140-6736(99)03057-3","article-title":"The epidemiology of chronic pain in the community.","volume":"354","author":"A Elliott","year":"1999","journal-title":"Lancet."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"287-333","DOI":"10.1016\/j.ejpain.2005.06.009","article-title":"Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.","volume":"10","author":"H Breivik","year":"2006","journal-title":"Eur J Pain."},{"key":"ref-18","doi-asserted-by":"publisher","first-page":"127-134","DOI":"10.1016\/S0304-3959(00)00355-9","article-title":"Chronic pain in Australia: a prevalence study.","volume":"89","author":"F Blyth","year":"2001","journal-title":"Pain."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/1471-2296-12-73","article-title":"Chronic pain among homeless persons: characteristics, treatment, and barriers to management.","volume":"12","author":"S Hwang","year":"2011","journal-title":"BMC Fam Pract."},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"2959-2966","DOI":"10.1001\/jama.296.24.2959","article-title":"End-of-life care for homeless patients: \"she says she is there to help me in any situation\".","volume":"296","author":"M Kushel","year":"2006","journal-title":"JAMA."},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"863-872","DOI":"10.1007\/s11136-009-9507-x","article-title":"Measuring pain in the context of homelessness.","volume":"18","author":"R Matter","year":"2009","journal-title":"Qual Life Res."},{"key":"ref-22","first-page":"129-138","article-title":"Pain assessment: global use of the Brief Pain Inventory.","volume":"23","author":"C Cleeland","year":"1994","journal-title":"Ann Acad Med Singapore."},{"key":"ref-23","doi-asserted-by":"publisher","first-page":"197-210","DOI":"10.1016\/0304-3959(83)90143-4","article-title":"Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases.","volume":"17","author":"R Daut","year":"1983","journal-title":"Pain."},{"key":"ref-24","doi-asserted-by":"publisher","first-page":"231-252","DOI":"10.1016\/S0039-6109(05)70381-9","article-title":"Measurement of pain.","volume":"79","author":"J Katz","year":"1999","journal-title":"Surg Clin North Am."},{"key":"ref-25","doi-asserted-by":"publisher","first-page":"191-197","DOI":"10.1016\/0304-3959(87)91074-8","article-title":"The short-form McGill Pain Questionnaire.","volume":"30","author":"R Melzack","year":"1987","journal-title":"Pain."},{"key":"ref-26","doi-asserted-by":"publisher","first-page":"147-157","DOI":"10.1016\/S0304-3959(00)00482-6","article-title":"The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs.","volume":"92","author":"M Bennett","year":"2001","journal-title":"Pain."},{"key":"ref-27","doi-asserted-by":"publisher","first-page":"1010-1018","DOI":"10.1111\/j.1468-1331.2010.02969.x","article-title":"EFNS guidelines on neuropathic pain assessment: revised 2009.","volume":"17","author":"G Cruccu","year":"2010","journal-title":"Eur J Neurol."},{"key":"ref-28","doi-asserted-by":"crossref","first-page":"309-318","DOI":"10.1097\/00002508-200409000-00005","article-title":"Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain.","volume":"20","author":"S Keller","year":"2004","journal-title":"Clin J Pain."},{"key":"ref-29","doi-asserted-by":"publisher","first-page":"1831-1836","DOI":"10.1001\/jama.280.21.1831","article-title":"Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial.","volume":"280","author":"M Backonja","year":"1998","journal-title":"JAMA."},{"key":"ref-30","doi-asserted-by":"publisher","first-page":"215-224","DOI":"10.1016\/S0304-3959(01)00407-9","article-title":"Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study.","volume":"94","author":"A Rice","year":"2001","journal-title":"Pain."},{"key":"ref-31","doi-asserted-by":"publisher","first-page":"1837-1842","DOI":"10.1001\/jama.280.21.1837","article-title":"Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial.","volume":"280","author":"M Rowbotham","year":"1998","journal-title":"JAMA."},{"key":"ref-32","doi-asserted-by":"publisher","first-page":"281-289","DOI":"10.1016\/j.jpain.2005.11.008","article-title":"The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey.","volume":"7","author":"N Torrance","year":"2006","journal-title":"J Pain."},{"key":"ref-33","doi-asserted-by":"publisher","first-page":"43-49","DOI":"10.1080\/0954026021000045930","article-title":"Substance misuse and psychiatric comorbidity: an overview of the OPCS National Psychiatric Morbidity Survey.","volume":"15","author":"M Farrell","year":"2003","journal-title":"Int Rev Psychiatry."},{"key":"ref-34","doi-asserted-by":"publisher","first-page":"1060-1070","DOI":"10.1353\/hpu.0.0344","article-title":"Health care access and utilization in older versus younger homeless adults.","volume":"21","author":"R Brown","year":"2010","journal-title":"J Health Care Poor Underserved."},{"key":"ref-35","doi-asserted-by":"publisher","first-page":"1047-1052","DOI":"10.1136\/bmj.311.7012.1047","article-title":"Anticonvulsant drugs for management of pain: a systematic review.","volume":"311","author":"H McQuay","year":"1995","journal-title":"BMJ."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/2-164\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/2-164\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/2-164\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,11,30]],"date-time":"2018-11-30T13:45:57Z","timestamp":1543585557000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/2-164\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,7,30]]},"references-count":35,"URL":"https:\/\/doi.org\/10.12688\/f1000research.2-164.v1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.870.r1780","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.870.r2090","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.870.r1780","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.870.r2090","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,7,30]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/2-164\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.870.r1780, Benjamin Henwood, School of Social Work, University of Southern California, Los Angeles, CA, USA, 04 Oct 2013, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/2-164\/v1#referee-response-1780","order":0,"name":"referee-response-1780","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.870.r2090, Lara Weinstein, Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia , PA, USA, 25 Oct 2013, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/2-164\/v1#referee-response-2090","order":1,"name":"referee-response-2090","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Rebecca Fisher<\/b>; \n<i>Posted: 28 Oct 2013<\/i>; The questionnaires used in the study are well validated and were chosen by the study team in part for ease of use with our study population, and also to provide comprehensive coverage of both neuropathic and non-neuropathic pain. There is little work on how to best measure pain in the context of homelessness (see reference 21, Matter \n<i>et al<\/i>), and we felt a combination of these questionnaires would allow a comprehensive assessment of pain, that was not overly burdensome to participants. References 22-28 provide further information on the questionnaires used in this study.We agree that trauma could have been added as a cause of lower limb pain in this population. Indeed several participants anecdotally mentioned abdominal stab wounds as contributing to their pain, and this could have been discussed further.We agree that the low percentage of women in the study limits its generalisability. In our study the small number of female participants reflected the overwhelmingly male occupancy of the night shelters at which participants were recruited. It would be interesting to expand the study to shelters catering only for women.&nbsp;","URL":"https:\/\/f1000research.com\/articles\/2-164\/v1#referee-comment-597","order":2,"name":"referee-comment-597","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The study was funded by the University Division of Anaesthesia and the School of Clinical Medicine at the University of Cambridge, UK. The sponsors played no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Data associated with the article are available under the terms of the Creative Commons Zero \"No rights reserved\" data waiver (CC0 1.0 Public domain dedication).","order":0,"name":"copyright-info","label":"Copyright"}]}}