Understanding Pain: What is a Pain Management Contract?

Dr. Harry Gould III, MD, PhD. is the author of Understanding Pain and Professor of Neurology at LSU and is one of the foremost authorities on managing pain.

Q: What is a “pain management contract” and why is my doctor asking me to sign one?

Dr. Gould: The pain management contract is the medical documentation of informed consent for treatment. Although it is technically not a contract in the legal sense, it establishes an outline of a working agreement between patient and provider. It is designed for the protection of both and is similar to the documents that are signed prior to undergoing any interventional procedure or treatment for which there is a significant potential risk for an undesired outcome.

In the area of pain management, the pain management contract is used for interventional procedures, e.g., nerve blocks, spinal injections, and for the medical management of those conditions that may require the use of potentially harmful and/or addictive medications. The document may vary from physician to physician but usually includes an explanation of the reasons for the treatments that may be provided. It should list the likely benefits and the potential risks of treatments to be offered and the benefits and risks of non-treatment.

It usually outlines what constitutes treatment failure and provides a general plan for treatment withdrawal in the event of such a failure. The document should outline responsibilities and expectations for both the patient and the provider and what the policy will be should either fail to comply with the agreement. The policies in pain management clinics may include required compliance with screening procedures for possible use of illicit drugs and pill counts, what happens in the event of lost prescriptions, self-medication [taking medications in a manner that is not prescribed unless discussed with the physician], the receipt of prescriptions from multiple physicians, or missed appointments.

The document should be read carefully by the prospective patient who should ask any questions deemed necessary to clarify the agreement. By signing the agreement the patient gives consent to the physician to be involved in their care as understood and stipulated in the document.