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

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.