Neurology Central

The pains of imprisonment: challenging aspects of pain management in correctional settings

While pain is the most common reason for seeking medical care [1,2], management of pain is among the most complex treatments that healthcare professionals have to deliver. Treating chronic pain in any setting can be experienced as frustrating or difficult for primary care providers [2]. Successful management of pain becomes even more complex and challenging in the setting of concomitant social or behavioral stressors, such as addiction disorders [3], mental health conditions [4] or a history of drug diversion to generate income [2]. In such cases, little research and few clinical algorithms exist to guide a rational approach to the clinical management of pain.

The complexity of providing pain management is particularly pronounced for healthcare professionals who treat patients in correctional settings (jails and prisons). The ethical provision of correctional healthcare is governed by the principle of equivalence, which mandates that the type and quality of healthcare delivered to prisoners should be at least equivalent to that received by community members in the prisoner’s given jurisdiction or country [5–7]. However, correctional clinicians’ adherence to the principle of equivalence is not always straightforward. Instead, many experience conflicts of interest (dual loyalty) as they find themselves practicing medicine in an institution where optimal healthcare delivery is at times overruled by security concerns [8]. Moreover, correctional healthcare professionals are often confronted with a population of patients that is categorically different than the outside community in terms of age, health conditions and a high prevalence of behavioral health stressors.

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