This new guide for professionals working in custody settings is an overview of best practice in managing persistent pain and describes how this practice might be implemented in secure environments, including prisons, police custody and immigration removal centres. It offers advice on confirming a diagnosis of persistent pain in a secure setting.

The guide has been written in association with the Faculty of Pain Medicine of the Royal College of Anaesthetists, the Royal College of General Practitioners and the British Pain Society, and is supported by the Department of Health.

Contents:
Introduction 3
Aims of the document 3

1. The context
1.1 The size of the problem
1.2 Trends in prescribing
1.3 Additional challenges in specific settings
1.3.1 Female prison estate
1.3.2 Male high-security prisons

2. Clinical issues 5
2.1 Diagnosis and prescribing
2.1.1 Diagnosing persistent pain
2.1.2 Diagnosing neuropathic pain
2.1.3 Diagnosing chronic visceral pain and poorly defined disorders
2.1.4 The role of opioids in managing persistent pain
2.1.5 Pharmacological management of neuropathic pain
2.1.6 Pharmacological management of chronic visceral pain and poorly defined disorders
2.2 Non-pharmacological management of pain
2.2.1 Psychological interventions
2.2.2 Physical rehabilitation

Endnote 9
Further reading 9
Process of preparation 10
Appendix 1 11
Appendix 2 11
Appendix 3. Suggested treatment pathways: Assessing and initiating pain management 12
Opioid therapy guidance pathway 13