Non-cancer pain clinic in three English prisons: understanding prisoner needs and prescribing practice in relation to chronic non-cancer pain (CNCP).
Int J Prison Health
; 14(4): 268-275, 2018 12 17.
Article
in En
| MEDLINE
| ID: mdl-30468110
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pain
/
Prisons
/
Practice Patterns, Physicians'
/
Health Services Needs and Demand
Type of study:
Prognostic_studies
Aspects:
Patient_preference
Limits:
Adult
/
Female
/
Humans
/
Male
Country/Region as subject:
Europa
Language:
En
Journal:
Int J Prison Health
Journal subject:
SAUDE PUBLICA
Year:
2018
Document type:
Article
Affiliation country:
United kingdom