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Like most facets of correctional healthcare, pain management is influenced by complexities on both sides of the exam room door.
For this month's discussion- inspired by Chris' recent co-presentation on pain management for the American College of Correctional Physicians Conference- we explore the environmental obstacles to effective pain management in incarcerated settings, the need for more data, and the underutilization of non-pharmacologic treatments. We also drill down on the three types of pain, multimodal analegesia, trauma in pain assessment, and spotlight a few emerging pain therapies.
Before that, the medication headlines:
- Juvmo for adults with Parkinson's Disease
- Onswik, the second weekly basal insulin approved in the US
- The latest osteoarthritis recommendations from the American College of Rheumatology
- Upgraded migraine prevention guidelines from the American Academy of Neurology and American Headache Society
And we finish up with a look back at a "shocking" non-pharmacologic pain treatment from ancient Rome.
Sponsor Links:
Music in this Episode:
The Retro Synth by Art Haiz
Vitals & Headlines (Suno AI)
Breezy Thoughts (Suno AI)
Trivia Time Ticker (Suno AI)
References/Further Reading:
Into the Clinic
[1] AbbVie. Juvmo prescribing information. Revised October 2026. Sections 2, 5, 7, 12, and 14.
https://www.rxabbvie.com/pdf/juvmo_pi.pdf
[2] AbbVie. FDA approval announcement for Juvmo. September 28, 2026.
https://news.abbvie.com/2026-09-28-U-S-FDA-Approves-AbbVies-JUVMO-TM-tavapadon-for-Parkinsons-Disease
[3] TEMPO-3 investigators.Tavapadon as adjunctive treatment for Parkinson disease. JAMA Neurology.2026;83:442–451.
https://doi.org/10.1001/jamaneurol.2026.0577
[4] FDA. FDA approves once-weekly insulin for type 2 diabetes mellitus.
https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-once-weekly-insulin-type-2-diabetes-mellitus
[5] Eli Lilly. Onswik prescribing information. See dosing, pen administration, medication errors, hypoglycemia, and clinical studies.
https://pi.lilly.com/us/onswik-uspi.pdf
[6] Wysham C, et al. Insulinefsitora versus degludec in type 2 diabetes without previous insulin treatment.NEJM. 2024;391:2201–2211. QWINT-2.
https://doi.org/10.1056/NEJMoa2403953
[7] American College of Rheumatology. 2026 update of recommendations for osteoarthritis of the knee, hip, and hand. Official summary, posted September 14, 2026.
https://assets.contentstack.io/v3/assets/bltee37abb6b278ab2c/bltb3d12c34020da842/oa-guideline-summary-2026.pdf
[8] Potrebic S, et al.Pharmacologic treatment for migraine prevention in adults practice guidelinerecommendations. AAN and AHS. First published August 31, 2026. Recommendations1–4 and 14–15.
https://doi.org/10.1111/head.70199
Main Discussion
[9] Bureau of Justice Statistics. Correctional populations in the United States 2023. Distinguishes incarceration from probation and parole.
https://bjs.ojp.gov/library/publications/correctional-populations-united-states-2023-statistical-tables
[10] Williams BA, et al. Pain behind bars: the epidemiology of pain in older jail inmates in a county jail. J Palliat Med. 2014;17:1336–1343. Original study of 210 adults age 55 and older.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4268586/
[11] Lin JT, Mathew P. Cancer pain management in prisons: a survey of primary care practitioners and inmates. J Pain Symptom Manage. 2005;29:466–473. Original Texas study.
https://pubmed.ncbi.nlm.nih.gov/15904749/
[12] National Commission onCorrectional Health Care. Management of chronic pain. Position statement, 2023.
https://ncchc.org/position-statements/management-of-noncancer-chronic-pain-2023/
[13] International Association for the Study of Pain. Official pain terminology, including nociceptive, neuropathic, and nociplastic pain.
https://www.iasp-pain.org/resources/terminology/
[14] Federal Bureau of Prisons. Pain management of inmates. Clinical guidance, June 2018. Historical correctional framework; use current labels and newer guidelines for prescribing decisions.
https://www.bop.gov/resources/pdfs/pain_mgmt_inmates_cpg.pdf
[15] Dowell D, et al. CDCclinical practice guideline for prescribing opioids for pain. MMWR.2022;71(RR-3):1–95. Scope excludes cancer pain, sickle cell disease, palliativecare, and end-of-life care.
https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
[16] Krebs EE, et al. Effect of opioid versus nonopioid medications on pain-related function. SPACE randomized clinical trial. JAMA. 2018;319:872–882.
https://doi.org/10.1001/jama.2018.0899
[17] FDA. Gabapentin and pregabalin drug safety communication on serious breathing problems. December 19, 2019.
https://www.fda.gov/safety/medical-product-safety-information/neurontin-gralise-horizant-gabapentin-and-lyrica-lyrica-cr-pregabalin-drug-safety-communication
[18] SAMHSA. Concept of trauma and guidance for a trauma-informed approach. 2014.
https://library.samhsa.gov/sites/default/files/sma14-4884.pdf
[19] VA Pharmacy Benefits Management. Buprenorphine for the management of chronic pain. National guidance, March 2024.
https://www.va.gov/formularyadvisor/DOC_PDF/CRE_Buprenorphine_for_Chronic_Pain_MAR_2024.pdf
[20] Butrans buprenorphinetransdermal system. Prescribing information, including respiratory depressionand CNS depressant warnings.
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=794aa355-66de-41b8-aedf-f2c40f6bc664
[21] Vertex. Journavx suzetrigine prescribing information. Sections 1, 2, 4, 7, 8, 12, and 14.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f0976da4-1d20-4517-945c-b60ed2f41c12
[22] Suzetrigine, a nonopioidNav1.8 inhibitor for treatment of moderate-to-severe acute pain: two phase 3randomized clinical trials. Anesthesiology. 2025. Original trial publication.
https://pubmed.ncbi.nlm.nih.gov/40117446/
[23] FDA. Approval of novel nonopioid treatment for moderate-to-severe acute pain. January 30, 2025.
https://www.fda.gov/news-events/press-announcements/fda-approves-novel-non-opioid-treatment-moderate-severe-acute-pain
[24] Binswanger IA, et al.Release from prison—a high risk of death for former inmates. NEJM.2007;356:157–165. Original cohort study.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2836121/
Trivia Capsule
[25] Scribonius Largus.Compositiones, remedy 11. Original Latin text, Packard Humanities Institute.Headache application, removal at numbness, and keeping multiple fish available;paraphrased for this segment.
https://latin.packhum.org/loc/1011/1/1
[26] Melzack R, Wall PD. Painmechanisms: a new theory. Science. 1965;150:971–979. Original gate-controlpaper.
https://doi.org/10.1126/science.150.3699.971
[27] Shealy CN, Mortimer JT,Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns:preliminary clinical report. Anesth Analg. 1967;46:489–491.
https://pubmed.ncbi.nlm.nih.gov/4952225/
