Pain compliance in restraint applications

Pain stimulus can be a deliberate or indiscriminate action executed by restraint practitioners with the objective of forcing the person being restrained to comply with instructions. Pain compliance is grounded in the prison version of control and restraint. This procedure has also filtered into the police and some psychiatric settings. The patient is restrained with his wrist held in the flexed position generically called “the wrist lock”. The pain is applied by exerting uncontrolled manual force on the flexed wrist, of the person being restrained. The wrist lock technique is the ultimate technique in the prison’s arsenal of restraint procedures and is adapted from the martial arts forms of Aikido and Ju-Jitsu.

The practical approach towards utilising the painful wrist lock technique is not fully explored in classroom training programme, which usually leads to indiscriminate applications. However, in practice, the resistive patient being restrained should be first allowed several opportunities to comply with given instructions. On failing to comply, a decision will be taken by the restraint team leader to apply the pain stimulus in order to exert compliance. For example immediately after the patient refuses to comply on the last occasion, one of the practitioners holding the person’s flexed wrist will be instructed to “apply pressure” on that wrist. The patient is supposed to associate the pain with not complying and might eventually choose to comply rather than experience further pain. There might be several attempts before it was realised that the pain stimulus was regarded as either effective or indeed ineffective.

The pain applications hardly follow the conventional protocol of administration in difficult real life restraint situations because in order for the wrist to be flexed it has to be in a relaxed position. However, in the immediate restraint situation, the patient’s wrist is often rigid and tense perhaps due to anxiety or fear or anger. During the restraint struggle to achieve the flexed wrist, there can be indiscriminate painful applications by either or both of the persons holding the person’s wrists, often resulting in the patient complaining of being hurt unnecessarily.

The essence of restraint is to subdue the individual safely and painlessly as possible when absolutely necessary using a compassionate humane approach.