Abstract
Background: Healthcare in Prison (HiP) aims to provide a quality, safe and effective service to all people in custody at least equivalent to that of the community. Our patients are often from the most marginalised parts of Northern Ireland and often have a high level of need, both from a mental and physical health perspective. Many of our patients are prescribed high doses of analgesics for chronic pain– this prescribing is inherited into the prison system due to the responsibility placed upon us to ensure continuity of medicines from community prescribers.
There has been a move away from the use of medication, including opioids, to treat chronic pain due to limited benefit. If medication is required, this should be in line with NICE Guidance and include non-pharmacological alternatives e.g self-management programmes. Until now access to programmes such as the Better days pain management programme was not available in our setting. SPPG Pharmacy funded a pilot programme led by a joint Healthcare in prisons (HIP) working group and Resurgam Trust was piloted in HMP Magilligan.
Approach: A multidisciplinary group including Hip pharmacists, nurses , physiotherapists and colleagues from Resurgam Trust agreed on recruitment of candidates, structure of course (to allow for local implementation given IT restrictions) and types of practical support deliverable. The programme was delivered over 6 sessions:
Week 1: Understanding pain + connecting with others living with pain
Week 2: Understanding Medicines for pain management
Week 3: What we eat and how it impacts pain
Week 4: Mental Health and Sleep
Week 5: Physiotherapy, movement and pain
Week 6: Holistic Therapies and managing flares
13 participants attended the programme. It helped them to understand their pain more fully using a holistic approach to pain management. It explored the role of medicines, current evidence based guidelines, prescribing rationale and the limited benefits and side effects of medicines in pain management. It included sessions on physiotherapy, mental health, sleep, eating well and 10 steps to living well with pain. These sessions were tailored specifically to the prison environment and helped to empower and support the men to help to manage their pain.
Results: Feedback from the participants was overwhelmingly positive with 64% of participants citing that they found the programme very helpful and 45% have indicated that they have reduced or cut down on their medication. There was a 16% reduction in the level of pain and discomfort and 17% reduction in anxiety and depression (as a result of chronic pain) participants experienced after programme completion. The programme demonstrated the positive impact of making pain management programmes available to people who live in prisons and the improvements that can be made over a relatively short period of time. By collaborative working with Norther Ireland Prison Service the programme achieved meaningful outcomes that (positively)impacted on our patients journey and empowered them in the management of their pain. These demonstrable outcomes evidence that support programmes allow those living with chronic pain to self-manage beyond medication.