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

• DOI: https://doi.org/10.1108/IJPH-11-2017-0052
• Pages: 268-275
• Published date: 17 December 2018
• Date: 17 December 2018
• Author: Arun Sondhi,Tina Garrett
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Non-cancer pain clinic in three English

prisons: understanding prisoner needs

and prescribing practice in relation to

chronic non-cancer pain (CNCP)

Arun Sondhi and Tina Garrett

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 implementati on 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 Offender health, Public health, Health promoting prison

Paper type Research paper

Introduction

Chronic non-cancer pain (CNCP) is a complex phenomenon determined and affected not just

by neurophysiological and anatomical processes, but also by a wide range of subjective,

societal and cultural considerations, all of which affect its pharmacological and psychosocial

management. The Int ernational Association fo r the Study of Pain define pain as “an unpleasant

sensory and emotio nal experience ass ociated with actua l or potential tiss ue damage, or

described in terms of such damage”(IASP, 2014) incorporating use of analgesics as part of an

individual’s treatment regime. Acute pain focusses on the underlying cause of the affliction and

after a period of 12 weeks’pain is considered a chronic condition requiring strategies to

manage the effects t o improve an individ ual’s ability to function and enhance their

day-to-day quality of life. Research has suggested that the average length of time a person

suffers from CNCP is around seven years often with considerable long-term personal and

psychological consequences (Breivik et al., 2006). Moreover, CNCP has been shown to be a

Received 8 November 2017

Revised 12 January 2018

23 March 2018

Accepted 26 March 2018

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.

Arun Sondhi is based at the

Therapeutic Solutions

(Addictions) Limited,

London, UK.

Tina Garrett is based at the

Department of Health and

Wellbeing, Public Health

England South Region,

Bristol, UK.

PAGE268

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VOL. 14 NO. 4 2018, pp. 268-275, © Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-11-2017-0052