Prevalence of chronic non-cancer pain in a UK prison environment

Abstract

Chronic non-cancer pain (CNCP) is significant global health issue, accounting for a substantial increase in prescription analgesics worldwide, in recent decades. This clinical burden is evident in the UK prison population, where the prevalence of CNCP has never previously been determined. This study, conducted in June/July 2013, used prescribing data and a systematic review of clinical records from two UK prison establishments to derive a figure for point-prevalence of CNCP. Results showed that 20% of the total aggregated prisoner rolls (N = 1944) described CNCP and had been in receipt of treatment with daily analgesia, for a period of at least 3 months prior to observation date. This prevalence of CNCP was related to increasing age group (Spearman's rank correlation 0.94). Of those on continuous analgesic therapy (CAT), 44% were taking continuous opioid therapy (COT) of any sort. Prisoners with a diagnosis of opioidtype drug dependence (OTDD) were more than twice as likely to complain of CNCP and be on continuous medication for it (odds ratio 2.3). The issues relating to CNCP in prisons are discussed. Further research is recommended, identifying factors influencing CNCP prevalence in prisons, and enabling comparisons to CNCP prevalence in the UK general population.

A qualitative study of reasons for seeking and ceasing opioid substitution treatment in prisons in New South Wales, Australia

“…This study did not set out to explicitly examine chronic pain and its management in custody, but the narratives provided by participants with chronic pain suggest some dissatisfaction with treatment options in custody. Evidence suggests that a substantial minority of prisoners is affected by chronic pain, and that there is a significant overlap between chronic pain and opioid dependence . For this reason, careful assessment of chronic pain on reception into custody is routinely undertaken and may uncover a history or evidence of aberrant drug using behaviours in some prisoners indicating the presence of a concurrent opioid use disorder for which transfer to OST is best practice management .…”

How Should a Health Care Professional Respond to an Incarcerated Patient's Request for a Particular Treatment?

“…Incarceration itself carries substantial risks to health, including a substantially reduced life expectancy [6]. As in this case, chronic pain is a common complaint managed by correctional health clinicians [7].…”

Prescription of pain medication in prisons: A comparative analysis of younger and older male prisoners

“…One study found high rates of severe frequent pain in prisoners 55 years and older, of which a majority received analgesics, including opioids . There are numerous recent publications on pain management at the end of life, focusing on palliative care, and a few empirical studies focusing on specific types of pain (eg, cancer pain or chronic noncancer pain) among prisoners. However, attention to pain management in prison has recently gained some traction, and there have been calls for guidelines in treatment of pain in the prison setting .…”