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.

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Global Genes Comments

  1. should I have to sign a pain med contract for a yearly nerve ablation if I am prescribed pain meds for 30 days after the ablation with no need for further meds thru the year ?

  2. In pain mom of 7 year old says:

    I’ve been 5 years same pain mgt dr@ 100mg methadone plus 30 10mg norco. Never a dirty test, nor missed appointment. Have ra, had discectomy age 27 have cellulitis in rt foot 2 years now, got spinal cortizone 2 yrs ago, requested another 6 months ago, not approved by insurance yet. she been lowering me 10mg/ev month for 3 months blaming on DEA. I’m now down to 70mg and having stabbing pain in butt cheeks,afraid she going to lower again, why is she doing this?

  3. I had battled with my PCP for over 8mo about my pain! I was showing signs of RA but I knew I didn’t have it! My pain was constant and not in my hand, primary a “fatigued” dull pain mostly in my back and it is constant with a pain level shifting between 7-9 frequently. My rheumetolgist unfornately was only part time, and she could only prescribe me Tramado;l. I REFUSE tramadol and prefer nothing if tylenol because that med for some reason make me feel as if I went to a wedding and I drank the champane on every table! My medications are a challenge and I let EVERY doctor know this before any thing else. in this situation, I am 7mo in with the group of MDs. I have had oxycodine hlc 10mg (I refuse the tyleol for obvious reasons) there are 90 take 1 10mg ever 4hrs as needed . That is a normal dose for me. Being post by pass, I ask for 10mg so I can break in half to 5gm as result of bypass the normal person takes tag 6-8hrs I take 5mg and I will absorb hopefully 2,3-3mg and in 2hrs its gone! That is why I break them Probleam was the next month the nodules spread and pain is worse, I am a hairstylist and figure skater so I handle pain! PCP writes me 30 5gm 1 every 6hrs. REALLY?!?!? I unfortunately had them gone by the end of the week. but waited the 30 days because I don’t want so seem as I am a drug seeker. This time I have an appt with both!! Rhumetologist tells me to kick her to the curb! If I ;leave I a,m :levant the entire place, that would mean her who I really like! I see me PCP first , she says I gained 8lbs and I need to watch it and I said “thats what prednisone does when you take it daily for 4 mo cause motrin isn’t an option. I did speak to my surgeon who said how amazing it is to see a patient 6 yrs out and you are still at 154 which your target was 157! told ,So you may think i am gaining but its from the meds and this is what I am suppose to weigh.” She went dead silent! I mentioned that since she refused to send me out of the group[ for pain mgt, my surgeon has suggested some fentynal patch? I had no clue at the time it what it was. She said no, it’s highly addictive and offered me morphine or dilauded instread?? WHERE IS THE RATIONAL IN THAT?!?!?!? I walked out went down the hall into my next appt in tears, she came over with my scrpit for 45 5mg oxycodone hcl 1 every 8hrs! EIGHT HRS!?!?!?!?!? At this point I have been on them for a year, I have them…she is worried a out addicton?!?! I told her I was taking 4-5 at a time becase I DO NOT ABSORBE! 2 more appt.s with the Rhum. and my hands and now feet are diasterous. I can barely get through one client at work and I am slowly losing passion. I switched primaries in Feb and it was the BEST move ever, He impressed me by everything he said! Horrified by the inconsistent perocet and more so when I said I didn’t want them! Couldn’t figure out why morphine or diluted and he said fentynal is STRONG, however you need pain management, I am no longer working because of this. He said I don’t absorb and the blood work show! He upped my fentynal and tested my urine and will every 30 days, and check to make sure the pharmacy I said I use is the one I got it filled at! I was so excited for a contact because I have never done one! I have

    • never been tested and I think anyone who is on a C2 or C3 medication should be!!! My new primary wants to make sure I am using it properly and not selling it! I was all for it! I think all Physicians should follow the contract! It is well worth it for the patiet and the licence of the MD

  4. Thanks for the information. I’ve been struggling with pain for the last few years. It seems like it won’t go away at all. I’m going to follow your tip about finding a pain management doctor. Do you have any other tips for me?

    • Dr. Harry Gould says:

      You may find some general tips to help in your approach to pain in the patient guide that I prepared for the American Academy of Neurology entitled, Understanding Pain. The text may provide additional general perspective to help communicate with your pain physician. The book is based on the many frequently asked questions that my patients asked about their pain over many years. Unfortunately, I am not sure what additional tips to offer that might be of special interest without some guidance. If specific questions remain after review of the general information, I will be happy to attempt to address them. I wish you luck.

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