Whether the location is a state prison or a local county jail, complaints of pain are extraordinarily common for physicians to encounter in clinical practice at a correctional facility. Pain is not like blood pressure or weight which can be easily measured. Pain is subjective and there is no test a physician can order to confirm or rule out the presence of pain.
Correctional physicians, like community physicians, are obligated to address complaints of pain. While a patient’s pain, particularly when it is long standing, is rarely – if ever – “perfectly” controlled, the general goal in addition to diagnosing the cause of the pain is not to overtreat by irresponsible prescribing and not to undertreat by brushing off complaints of pain and offering an insufficient treatment plan. Both extremes are harmful to patients and accordingly do not meet standard of care.
Acute pain which is pain that has just developed for a patient is generally easier for a physician to contend with. Typically, the history is more straight forward (ankle sprain or finger fracture for example) and the treatment; ice, splinting, sutures, anti-inflammatory medications and so forth is similarly straightforward. Pain that is protracted and problematic for a patient over a longer period is referred to as chronic pain. All physicians including those in corrections have an obligation to address and manage chronic pain. Chronic pain management in a correctional setting is challenging for a number of reasons:
1/ Incarcerated individuals frequently come from medically underserved segments of the community with several if not many chronic medical conditions, including chronic pain, that having not been maintained in the best state of control.
2/ Incarcerated individuals frequently have personal histories of substance abuse and addiction and some medications, opioids for example, that can be used to treat chronic pain are addictive and abusable themselves and accordingly require diligent prescribing on a risk vs benefit basis.
3/ Some pain medications in addition to being abused are also trafficked or diverted in correctional facilities which is a security risk and explains why correctional authorities are understandably wary of these medications. “Diversion” is the term used when pain medication intended for one patient ends up being taken by another.
(Up next: Part 2 – What does standard of care for chronic pain in a correctional facility require?)