No Place to Rest: Housing Instability and Pain Experiences in the Emergency Department

Introduction: Housing instability increases chronic pain risk and creates care barriers, making emergency departments the primary points of health care for people experiencing housing instability. Although it is clear that housing instability contributes to chronic pain, the patient's experience of pain is less understood. This study examines differences in pain characteristics by housing status. Methods: This secondary analysis used data from the Decision-Making Factors for Therapeutic Opioid Use after Emergency Care. In the original study, randomly selected eligible participants self-reported housing status, in addition to validated measures of pain interference, pain self-efficacy, pain anxiety, depression, and sleep disturbances. Regression models explored the relationship between housing status and pain-related outcomes adjusting for demographics. Results: Among participants (N = 496), 47 (9.5%) reported unstable housing. Compared with stably housed patients, those with unstable housing had higher adjusted odds of current (adjusted odds ratio, 2.05; 95% CI, 1.11-3.86) and lifetime chronic pain (adjusted odds ratio, 2.40; 95% CI, 1.28-4.58) and higher pain-related anxiety scores (β = 13.43; 95% CI, 6.51-20.35), depressive symptoms (β = 4.62; 95% CI, 2.83-6.41), and sleep disturbance (β = 2.37; 95% CI, 1.07-3.54). No differences were found in pain self-efficacy (β = −0.78; 95% CI, −6.88 to 3.62). Discussion: Unstably housed emergency department patients experience higher rates of chronic pain and pain-related anxiety while maintaining similar pain self-efficacy. Systems-level interventions that address social and structural barriers to pain management among unstably housed patients are needed to improve pain management and reduce emergency department burden. The results should be interpreted with caution given the small sample size and large confidence intervals.