title: Managing pain in prison: staff perspectives.
abstract: OBJECTIVE
  The purpose of this paper is to present the findings of one part of a larger study, funded by the National Institute for Health Research, which explored the management of pain in adult male prisoners in one large category B prison in England. In this paper, the authors focus on the attitudes and perceptions of prison staff towards pain management in prison.
  
  
  METHODS
  A qualitative design was utilised to explore the staff perceptions of pain and pain management in one adult male prison. Questionnaires were provided for all staff with prisoner contact, and a follow up focus group was undertaken to further explore questionnaire data.
  
  
  RESULTS
  The questionnaire and focus group findings demonstrated that staff had a good awareness of pain and pain management in prison, with both physical and emotional pain identified. The frequency of approaches by prisoners to staff for pain relief was noted to be high, whilst awareness of how the prison environment could potentially exacerbate pain was discussed. The acquisition of analgesia by prisoners for secondary gain was identified as a challenge to both assessing levels of pain and providing pain relief in prison, illustrating the complexity of providing care within a custodial culture. The effect on staff of caring for prisoners found to be confrontational and deceitful was significant for participants, with feelings of anger and frustration reported. Research LIMITATIONS/IMPLICATIONS: This study was undertaken in one adult male category B prison with a very high turnover of prisoners. Staff working in other types of prison, for example, higher security or those more stable with longer sentenced prisoners could provide alternative views, as may staff caring for younger offenders and women. The challenges to undertaking research in prison with staff who can understandably be reluctant to engage in reflection on their practice cannot be underestimated and impact significantly on available methodologies.
  
  
  CONCLUSIONS
  This qualitative research is the first of its kind to offer the perspectives of both health care professionals and prison staff working with prisoners complaining of pain in an English prison. It provides the groundwork for further research and development.
authors.affiliation: Associate Professor: Offender Health, based at School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Walsh
authors.forename: Christine
authors.initials: C
authors.lastname: Butt
authors.forename: Dawn
authors.initials: D
authors.lastname: Freshwater
authors.forename: Rachael
authors.initials: R
authors.lastname: Dobson
authors.forename: Nat
authors.initials: N
authors.lastname: Wright
authors.forename: Jane
authors.initials: J
authors.lastname: Cahill
authors.forename: Michelle
authors.initials: M
authors.lastname: Briggs
authors.forename: David
authors.initials: D
authors.lastname: Alldred
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D004739:England; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010465:Perception; D011330:Prisons
chemical_list: D000700:Analgesics
keywords: Analgesia; Correctional health care; Prison staff