Living with Chronic Pain

Pain Management Contracts

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Due to the increased use of opioids, opioid addiction, and opioid overdoses in the United States, many physicians have instituted the use of pain management contracts. A pain management contract (or pain management agreement) is a written description of the long-term effects, benefits, and risks of certain medications, especially opioids. It includes strict guidelines for the proper use of the medication and is signed by both the patient and the physician. The fundamental purpose of the contract is to create an ongoing dialogue between physician and patient about their chronic pain treatment and the guidelines of responsible opioid use. As a result, the patient is better informed, and the physician is able to effectively monitor the patient's adherence to the medication dosage and schedule. Pain management agreements are beneficial for both the doctor and the patient. The agreement provides information regarding opioid side effects and risks of dependence, addiction, and overdose. The agreement often covers other risks, such as the consumption of alcohol and other medications while taking opioids.

In a pain management contract, the patient agrees to not obtain opioids from any other source (including other physicians or health care facilities) and to use only one pharmacy. Some patients, especially long-time responsible users of opioids, feel like they are being treated as if they are drug abusers when they genuinely require the medication(s) for severe pain relief. Patients should discuss their pain-treatment plan with their physician and share any concerns about the contract, and physicians should respectfully clarify and explain anything that is confusing or concerning to the patient. Also, patients should be aware of how the contract affects emergency care. For example, if the patient is in a car accident and requires emergency attention, does the agreement become null and void if opioids are prescribed in the hospital or for aftercare?

A pain management agreement is not a legally binding contract, nor are they legally enforceable. However, a cosigned document provides solid evidence that a dialogue occurred between the physician and the patient; therefore, it may lower the risk of malpractice litigation. A pain management agreement is strictly an agreement between physician and patient. It provides strict guidelines regarding how the doctor and patient will work together to manage the patient's pain. It is imperative that the patient is aware of all facets of the agreement and that the physician monitors the patient's progress to ensure the patient is responding favorably to the medication and dosage while faithfully following the treatment plan.

Patients have the right to procure their monthly prescription on the due date, have the effect of the medication monitored, and receive proper medical care from the physician. Only the patient should determine if other family members and/or caretakers are included in the decision-making process. It is important to note that patients can also request information about alternative methods to treat their pain. If a patient fails to follow the agreement, the physician will cease to treat him/her for chronic pain.

Not only should the patient be held accountable to uphold the terms of the pain management agreement, but the physician should also be proactive in ensuring the guidelines for both patient and physician are followed. The doctor or health care professional should perform random urine drug screenings to ensure the patient is adhering to the agreement. The physician should also ensure that prescriptions are not refilled until the appropriate time. Furthermore, blood tests may be required to check for illegal substances or abuse of the prescribed medication. The doctor can also implement random "pill counts" to make certain the patient is not taking more than prescribed and/or sharing the medication with others. If the patient takes more medication than prescribed or uses other mind-altering drugs, such as alcohol or street drugs, the physician has the right to terminate treatment of the patient for chronic pain, and therefore, no longer prescribe pain medications to that individual.


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