Cancer Pain Management in Prisons: A Survey of Primary Care Practitioners and Inmates

Abstract

Cancer pain management among prison inmates is an emerging problem. To examine the obstacles to cancer pain management in inmates, surveys of inmates with cancer pain (IPs) (n = 102) and primary care practitioners (PCPs) (n = 74) in Texas state prisons were conducted. IPs were assessed using the Brief Pain Inventory and Pain Management Index (PMI). PCPs were assessed with a modified Clinic Staff Survey of Cancer Pain Management. Eighty-three IPs (81%) reported severe worst pain; 51 (49%) reported severe average pain. Thirty-three IPs (32%) reported no pain relief with prescribed analgesics. PMI was negative in 65 IPs (64%), indicating undertreatment. Of the PCPs, 20/65 (31%) felt that IPs were undertreated. Most frequently cited barriers to pain management were drug misuse/diversion and lack of inmate credibility. Practitioner problems and systemic barriers also were cited frequently. These results indicate the existence of unique barriers to undertreatment of cancer pain in IPs. A multidisciplinary approach involving prison authorities and practitioners is required to improve pain management in prison populations.

The Pains of Imprisonment: Challenging Aspects of Pain Management in Correctional Settings

“…This blurring of the lines between punishment and medical care can have an impact on pain management for prisoners [9]. For example, some correctional settings have severely restricted the availability of opioids even for patients with severe pain [10].…”

“…While the correctional setting is unique and the medical needs of prisoners are often complex, research on optimizing pain management for prisoners is scarce. Few studies have investigated pain management among prisoners and those that have are often very For reprint orders, please contact: reprints@futuremedicine.com specific, focusing only on certain types of pain (such as cancer pain) [9], a certain stage of illness or type of treatment (such as palliative care) [10] and/or specific demographic populations (such as older adults) [11]. While a focus on palliative care and pain management for older adults is understandable, given the rising numbers of older prisoners [11] and increasing numbers of prisoners dying while incarcerated due to longer sentences [10], few if any studies have comprehensively assessed the epidemiology of pain or approaches to pain management among a diverse population of prisoners.…”

“…While a focus on palliative care and pain management for older adults is understandable, given the rising numbers of older prisoners [11] and increasing numbers of prisoners dying while incarcerated due to longer sentences [10], few if any studies have comprehensively assessed the epidemiology of pain or approaches to pain management among a diverse population of prisoners. Rarely have studies compared differences in pain and pain management between prisoners and the community [9].…”

Cancer in an incarcerated population

“…One example is the provision of effective cancer pain control with opioids in a population in which it is known that drug abuse and misuse are common. 20 Another challenge is that the diagnosis of a terminal illness does not guarantee parole; therefore, more patients are dying in prison from cancer than were dying previously. Prison hospices that are available in Texas offer supervised environments in which effective palliative care may be delivered.…”

Palliative and End-of-Life Care in Correctional Settings

“…In addition to guidelines mentioned previously, practical advice and the voice of experience are important in adequately addressing pain and other symptoms (Bick, 2002;Lin & Mathew, 2005) Many inmates have a history of substance abuse, either through their own use or as a consequence of others' addiction. In this, several issues arise.…”