Living with Chronic Pain

What Is a Pain Management Contract?


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.

What is a pain management contract?

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 individual being treated and their prescribing physician.

What is the purpose of a pain management contract?

The fundamental purpose of a pain management contract is to create an ongoing dialogue between the physician and the person they are treating about their chronic pain treatment and the guidelines of responsible opioid use. As a result, the individual dealing with chronic pain is better informed, and the physician is able to effectively monitor proper adherence to the medication dosage and schedule.

What are the benefits of a pain management contract?

Pain management agreements are beneficial for both the doctor and the person receiving treatment. 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.

How does a pain management agreement work?

In a pain management contract, the person being prescribed opioids agrees not to obtain opioids from any other source (including other physicians or health care facilities) and to use only one pharmacy. Some people, 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. The pain treatment plan should be discussed with the physician and any concerns about the contract should be shared.

What are the legal implications of a pain management contract?

Pain management agreements are not legally binding contracts nor are they legally enforceable. However, a cosigned document provides solid evidence that a dialogue occurred between the physician and the person that is being prescribed opioids; therefore, it may lower the risk of malpractice litigation. A pain management agreement is strictly an agreement between a physician and the person they are treating. It provides strict guidelines regarding how the doctor and the individual in pain will work together for effective pain management.

What are the rights and responsibilities of the individual?

It is imperative that the individual is aware of all facets of the agreement and that the physician monitors the person's progress to ensure that they are responding favorably to the medication and dosage while faithfully following the treatment plan. Individuals 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 their physician. Only the treated individual should determine if other family members or caretakers are included in the decision-making process. If the individual fails to follow the agreement, the physician can cease to treat them for chronic pain. It is important to note that information may be provided about alternative pain management treatments.

What are the rights and responsibilities of the physician?

Not only should individuals be held accountable to uphold the terms of a pain management agreement, but physicians should also be proactive in upholding the guidelines. Physicians should be prepared to respectfully clarify and explain anything that is confusing or concerning in the contract. Also, the individual should be made aware of how the contract affects emergency care. For example, if the individual 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?

The doctor or health care professional should perform random urine drug screenings to ensure adherence 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 individual is not taking more than prescribed or sharing the medication with others. If the individual receiving treatment 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, and therefore, no longer prescribe pain medications to that individual.

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