Download Pain Management Contract FAQ

FAQ-Pain Management Agreement
Question: Are we required to have patients sign a pain management contract when prescribing pain
medications?
Answer: New Texas Medical Board rules for pain management went into effect on August 4, 2015.
Please see specifically, Rule §170.3, Minimum Requirements for the Treatment of Chronic Pain:
(4) Agreement for treatment of chronic pain. A proper patient-physician relationship for treatment
of chronic pain requires the physician to establish and inform the patient of the physician's
expectations that are necessary for patient compliance. If the treatment plan includes extended
drug therapy, the physician must use a written pain management agreement between the
physician and the patient outlining patient responsibilities, including the following provisions:
(A) the physician may require laboratory tests for drug levels upon request;
(B) the physician may limit the number and frequency of prescription refills;
(C) only one physician will prescribe dangerous and scheduled drugs;
(D) only one pharmacy designated by the patient will be used for prescriptions for the
treatment of chronic pain, unless the designated pharmacy under the agreement is out of stock of
the drug prescribed at the time that the prescription is communicated by the physician to the
pharmacy or patient presents to have the drug dispensed; and
(E) reasons for which drug therapy may be discontinued (e.g. violation of agreement).
Please visit the Texas Pain Society's website to obtain a sample Pain Management Agreement and
Informed Consent Forms: http://www.texaspain.org/informed-consent.
The following Texas Medicine articles may also be helpfulPain Rules are a Pain for Doctors
Regs and Pains
Additionally, the Intractable Pain Treatment Act (Occupations Code, Chapter 107) regulates physicians
who treat drug-abusing patients (or patients with a history of abuse) for intractable painSUBCHAPTER C. TREATMENT OF CERTAIN PATIENTS
Sec. 107.101. PATIENT. In this subchapter, "patient" includes a person who:
(1) is currently abusing a dangerous drug or controlled substance;
(2) is not currently abusing such a drug or substance but has a history of such
abuse; or
(3) lives in an environment that poses a risk for misuse or diversion to
illegitimate use of such a drug or substance.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 14.002(a), eff. Sept. 1, 2003.
Sec. 107.102. AUTHORITY TO TREAT. This chapter authorizes a physician to treat a
patient with an acute or chronic painful medical condition with a dangerous drug or controlled
substance to relieve the patient's pain using appropriate doses, for an appropriate length of time,
and for as long as the pain persists.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 14.002(a), eff. Sept. 1, 2003.
Sec. 107.103. DUTY TO MONITOR PATIENT. A physician who treats a patient
under this subchapter shall monitor the patient to ensure that a prescribed dangerous drug or
controlled substance is used only for the treatment of the patient's painful medical condition.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 14.002(a), eff. Sept. 1, 2003.
Sec. 107.104. DOCUMENTATION AND CONSULTATION REQUIRED. To ensure
that a prescribed dangerous drug or controlled substance is not diverted to another use and to
ensure the appropriateness of the treatment of the patient's targeted symptoms, the physician
shall:
(1) specifically document:
(A) the understanding between the physician and patient about the
patient's prescribed treatment;
(B) the name of the drug or substance prescribed;
(C) the dosage and method of taking the prescribed drug or substance;
(D) the number of dose units prescribed; and
(E) the frequency of prescribing and dispensing the drug or substance;
and
(2) consult with a psychologist, psychiatrist, expert in the treatment of
addictions, or other health care professional, as appropriate.
For more information on registration of pain management clinics and other frequently asked questions,
please visit the Texas Medical Board website:
http://www.tmb.state.tx.us/page/renewal-pain-mgt-clinic-pegistration
http://www.tmb.state.tx.us/page/renewal-faqs
You may also want to review Chapter 195 of the Texas Medical Board rules related to pain management.
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