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Non-cancer pain clinic in three English prisons: understanding prisoner needs and prescribing practice in relation to chronic non-cancer pain (CNCP)

Arun Sondhi (Therapeutic Solutions (Addictions) Limited, London, UK)
Tina Garrett (Department of Health and Wellbeing, Public Health England South Region, Bristol, UK)

International Journal of Prisoner Health

ISSN: 1744-9200

Article publication date: 17 December 2018

Abstract

Purpose

Prisoner access to opiate-based analgesics and gabapentinoids is a concern to prisons through illicit trading. The purpose of this paper is to describe patient needs following introduction of nine pilot chronic non-cancer pain (CNCP) clinics for chronic pain in three prisons (two male and one female) in the South of England. The study evaluated the effectiveness of this model and assessed the wider practical implementation issues.

Design/methodology/approach

Clinical notes were reviewed for 63 consultations, anonymised and recorded for secondary analysis.

Findings

Alongside CNCP, high levels of substance misuse, physical and mental health histories were noted, especially for female patients. Amitriptyline, pregabalin, gabapentin were the main frontline analgesics prescribed prior to assessment. A total of 41 per cent of patients did not change their medication following the consultation; 25 per cent had their medication increased or reintroduced (greater for women prisoners); with one-third (33 per cent) of patients reducing the prescription of strong opioids and gabapentinoids. Significant differences were noted between male and female patients. Prisoners were amenable to changes in medication to facilitate access to work and other therapeutic interventions.

Social implications

The prescribing of analgesics has largely been couched in terms of disruption to the prison regime through illicit trading. This study highlights the need to place CNCP within wider contexts of substance misuse, physical and emotional health. There is an opportunity to develop a rehabilitative rather than palliative approach to pain management. Gender specific approaches for female patients should be considered.

Originality/value

Few studies of CNCP have been conducted within a prison environment.

Keywords

Acknowledgements

The study and pilot clinics were funded by NHS England Health and Justice Team and run by Dr Cathy Stannard, supported by Dr Catherine Glover. The Authors declare that there is no conflict of interest. The authors thank Kieran Lynch and Dr George Ryan at Public Health England for comments on earlier drafts.

Citation

Sondhi, A. and Garrett, T. (2018), "Non-cancer pain clinic in three English prisons: understanding prisoner needs and prescribing practice in relation to chronic non-cancer pain (CNCP)", International Journal of Prisoner Health, Vol. 14 No. 4, pp. 268-275. https://doi.org/10.1108/IJPH-11-2017-0052

Publisher

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Emerald Publishing Limited

Copyright © 2018, Emerald Publishing Limited