EK HEALTH

The following is a guest article by Joel Mata, MD, a board-certified anesthesiologist who is passionately involved with our Next Step program that deals with the most difficult chronic pain patients. The Pain Treatment Agreement (pain contract) attached is based upon, and supported by, the California MTUS. You are welcome to use it for the benefit of patient management. - Richard Thompson, MD, EK Health Services' Chief Medical Officer

  The practice of medicine is becoming increasingly complex.  When faced with chronic pain patients, we are responsible for understanding and appropriately treating the pathophysiology of the disease, which is often extremely challenging because of conflicting and competing concerns.

These concerns include issues of secondary pain, evolving treatment guideline requirements, drug and addiction issues, and legal implications.   Managing patients with chronic pain may include a variety of treatment modalities including pharmacotherapy.

When treating chronic pain patients who are taking powerful and addicting medications, it is important to establish treatment and functional expectations and limitations as part of in the physician/patient relationship. This usually involves direct communication, office handouts and flyers, and a Pain Treatment Agreement.

The purpose of the Pain Treatment Agreement is to confirm drug treatment protocols and enhance physician-patient trust. Typically, the patient reviews and signs this document prior to receiving prescriptions for controlled medications.  It clarifies office policies regarding pharmacotherapeutic protocols, concurrent use of illegal substances and the consequences of agreement violations.

The Pain Treatment Agreement helps protect the treating physician’s practice by providing clear guidelines that patients can easily understand, as well as reinforce policies that the physician and patient can refer back to when necessary.