title: 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.
authors.affiliation: Department of Internal Medicine, The University of Texas Medical Branch, Galveston, 77030, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Lin
authors.forename: Paul
authors.initials: P
authors.lastname: Mathew
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000209:etiology*; D010166:Palliative Care / Q000592:standards*; D010821:Physicians, Family; D011330:Prisons; D011795:Surveys and Questionnaires; D013781:Texas