Chronic Noncancer Pain Management Guideline
Management of chronic noncancer pain (CNCP) poses an enormous challenge to correctional health professionals and patients. A growing number of detainees enter correctional facilities each year with prescriptions for opioids. Yet, opioids are potentially problematic in correctional settings due to risk factors such as substance abuse, psychological and physiological dependence, drug diversion, overdose and complications. In addition, continuity of opioid care is challenging to arrange because few community physicians are willing to prescribe it for CNCP to persons recently released from a correctional facility. To help clinicians deal with this complicated issue, the National Commission on Correctional Health Care has issued a guideline for disease management on chronic noncancer pain management.
The general approach to CNCP management in corrections includes the following:
- Pain reduction goal set at a realistic 20% to 30%
- Focus on maximizing daily function despite some pain persistence
- Patient education, with a focus on attainable goals
- Minimization of harm to patients and others
The guideline includes suggestions for nonpharmacological treatments such as heat and cold, stretching and physical therapy. For pharmacological treatment, the guideline highlights the importance of dose monitoring and follow-up and provides specific guidelines on prescribing opioids.