5 Things to Know Before Signing a Pain Management Contract (2023)

If you struggle with chronic pain, you may have been prescribed an opioid medication. It is also likelythat you have been asked to sign a pain management agreement or opioid treatment agreement. These agreements are commonly known as "opioid contracts" or "pain contracts." If this is the case, it is important that you understand what is being asked of you before you sign the contract.

What Is a Pain Management Agreement?

A pain medication agreement is a contract between a doctor and a patient. The goal of the agreement is to ensure that patients who are taking opioid drugs do so exactly as their doctor has prescribed.

In theory, these agreements are not onlydesigned to protect the patient from drug abuse, but they also protectthe doctor in case the patient abuses the medication in some way.

Years ago,pain medication agreements were rare. They were only required by pain clinics and pain management specialists. But with the increase in opioid addictions, and the scrutiny of the Drug Enforcement Administration (DEA) on doctors who prescribe the medications, more general and family practitioners also are requiring patients who take long-term opioid pain medication to sign them.

Pain Management Agreement Details

Although the details of every agreement vary from doctor to doctor, there are a number of elements that are consistent throughout. Here is an overview of the top five things you need to know about pain management agreements before you sign your name.If you cannot agree to these basic elements, then a pain management agreement may not be right for you.

Take Medication As Prescribed

You must agree to take the medication exactly as prescribed. What this means is that you must take the exact amount prescribed at the exact time intervals or risk being terminated from the agreement. So, even if you feel like you do not need to take your pain medication one day, you still must take it. You cannot decrease your intake or save meds on a low-pain day to take later on a high-pain day.

Likewise, if you feel that you need more pain medication on a given day, you have to be willing to do without the extra dose unless your doctor writes a new prescription. Do not, under any circumstances,change the dosage on your own.

Many doctors do drug testing and if they find you have too much in your system, they may assume you are abusing the drugs. Likewise, if you have too little of the drug in your system, they may think you are selling the medication or giving it to someone else.

Drug Testing Is Permitted

You must agree to random drug testing. This stipulation is usually part of the agreement because doctors want to ensure you are not abusing the drugs. They also want to be sure you are the only one using the medication. As a result, they randomly test you and then measure how much of the drug is in your system.

Remember, because prescription drug abuse is so prevalent today, doctors have to be extra careful. It's not that they do not trust you or think that you are a drug addict. They could lose their medical license and face criminal prosecution ifthey are prescribing controlled substances to people who are either abusing them or selling them to others. As a result, these agreements are designed to protect them.

What's more, pain management agreements typically require you to keep all your scheduled appointments and only allow for one or two cancellations before terminating you as a patient. They make this stipulation to keep patients from canceling because they fear the drug test will reveal that they are not taking their medications as prescribed.

Only One Pharmacy Is Allowed

You agree to get all your prescriptions filled atone pharmacy, and you agree to allow the doctor and pharmacist to share information about you. When people abuse drugs, they often try to getprescriptions from multiple doctors and then fill them at different pharmacies.

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Because prescriptions are now entered into computers often with interconnected databases, this practice is currently much more difficult to get away with.Consequently, if you sign an agreement with your physician, be sure you only shop at one pharmacy.

No Replacement Medication

You agree that lost, stolen or destroyed medications will not be replaced.If this stipulation is part of your pain management contract, be sureyou safeguard your medications at all times.

There are some agreements that allow a doctorto use his own discretion if your medication is stolen and you file a police report. But remember, he usually is not required to replace the stolen medication. So you will be forced to do without pain medication until your prescription can be renewed.

Prescriptions Come From One Provider

You agree not to request nor take pain medications from other healthcare providers. Even if you visit the dentist or the emergency room, these doctors cannot prescribe pain medications for you. And, if they do, you will be violating your pain management agreement.

Only your pain management doctor can prescribe pain medications.And pain management contracts typically require you to make all other healthcare providers aware of your agreement.

As a result, if other doctorswant to prescribe medications for your injury or after oral surgery, they will need to go through your pain management doctor. Due to the drug tests you are taking, your pain management doctor will be able to tell if you have taken something that he has not prescribed. You don't take medications prescribed by other physicians without talking with your pain management doctor first.

Major Concerns of Pain Management Contracts

Generally,doctors who use these contracts say they are an effective way to let patients know what to expect while under their care. They also believe the contracts let patients know how to use the medications safely, including how to store them at home. But critics of the agreements worry that the contracts undermine the patient-doctor relationship.

For instance, they are concerned that the contracts put those suffering from chronic pain at the mercy of the provider. They maintainthat those with chronic pain are already vulnerable and that the agreement shifts the balance of power in favor of the doctor, leaving the patient disempowered and at risk.

Another concern is thatthe contracts are often worded in a way that is offensive to patients, which in turn creates animosity between the doctor and the patient. Meanwhile, some patients feel as though they were treated like drug addicts despite the fact that they have always used their medications responsibly.

Precautionary Measures for Pain Management Agreements

If you are asked to sign a pain management agreement,it is essential that you understand every detail of what you are signing. This way, you will be able to abide by all the rules and stipulations spelled out in the contract. If you do not understand something, be sure to ask. Remember, failing to follow all the terms of the agreementcan have dire consequences.

For instance,if you do not follow the agreement or do something that is forbidden, your doctor may refuse to prescribe any additional pain medications for you. You also could be dismissed as a patient. And if you are dismissed, it can be much harder to find another doctor to take you as a patient and treat your condition.

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A Word From Verywell

Be sure youcarefully readevery word of the agreement before you sign it. Ask questions about anything that is unclear to you. Then, think about whether or not signing the agreement is the best option for you. And if you do agree to sign the contract, make sure you follow it word for word. You don't want to find yourself in a situation where you can no longer get pain medications for your condition.

2 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Center for Practical Bioethics, PAINS Project. "Opioid Treatment Agreements or Contracts: Proceed with Caution."Issue 4; Spring 2014.

  2. Rager JB, Schwartz PH. Defending Opioid Treatment Agreements: Disclosure, Not Promises. Hastings Cent Rep. 2017;47(3):24-33. doi:10.1002/hast.702

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5 Things to Know Before Signing a Pain Management Contract (1)

By Sherri Gordon
Sherri Gordon is a published author and a bullying prevention expert.

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What questions should I ask my pain management? ›

History of Your Pain
  • What caused my pain in the first place?
  • Did my pain start suddenly or gradually?
  • How long have I been in pain?
  • What am I currently doing to manage my pain?
  • Is there anything I'm doing that's reducing my pain?
  • What pain medications have I taken in the past, and how did they work for me?

How can I get my doctor to give me pain meds? ›

Say “I am in severe pain.” This time your doctor will respond! With an eye roll. Followed by a reminder that all your blood work is negative and you don't “look sick.” Leave the doctor's office, you dramatic exaggerator, you! 3.

What pain medication is not a controlled substance? ›

Some examples of non-opioid pain medications include over the counter medications such as Tylenol (acetaminophen), Motrin (ibuprofen), and Aleve (naproxen). Some prescription medications may also be used to manage pain. Neurontin (gabapentin) is often prescribed to manage nerve pain.

What narcotic is used for severe pain? ›

Opioids, powerful pain medications that diminish the perception of pain, may be given after surgery. Intravenous opioids may include fentanyl, hydromorphone, morphine, oxycodone, oxymorphone and tramadol.

What is included in a pain assessment? ›

Patients should be asked to describe their pain in terms of the following characteristics: location, radiation, mode of onset, character, temporal pattern, exacerbating and relieving factors, and intensity. The Joint Commission updated the assessment of pain to include focusing on how it affects patients' function.

How would you describe chronic pain to the doctor? ›

Tell your doctor all of the areas you are experiencing pain. Don't say the pain is in your leg. Explain and point it out to where the specific pain is in your leg. Does the pain transfer to your feet at all?

What does it mean to be red flagged by a doctor? ›

Being 'red flagged' is a term used to signify that there is potentially suspicious behavior in regard to controlled substance abuse, misuse, or diversion. In other words, it is simply a warning sign. However, there is no state or federal database that lists or records patients with a permanent "red flag" however.

How do you find out if you are red flagged at a pharmacy? ›

Related Articles
  1. Look into your medical history. ...
  2. Go to a reputable pharmacy and ask for a dosage of your regular prescribed medication. ...
  3. If the pharmacist denies you the medication, then you are Red Flagged, as they would have to consult an online system that tracks when your next dosage should be given.

Can a doctor refuse to give you pain medication? ›

Know your rights!

As someone with a diagnosed, painful condition, your care team has a moral and ethical obligation to help you. In saying this, your physician can refuse you pain medication or deny you as a patient.

What is the most common medication for pain? ›

There are two main types of OTC pain medicines: acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin) are examples of OTC NSAIDs. If OTC medicines don't relieve your pain, your doctor may prescribe something stronger.

What is the strongest painkiller? ›

Vivien Williams: Fentanyl is a powerful painkiller. Mike Hooten, M.D. (Anethesiology, Mayo Clinic): It is many, many times more potent than morphine, oxycodone, oxycontin, Vicadin, dilaudid, hydromorphine, all these types of drugs. Vivien Williams: Mayo Clinic pain management specialist Dr.

Which is stronger hydrocodone or oxycodone? ›

Both oxycodone and hydrocodone are powerful, but oxycodone is approximately 50% stronger than hydrocodone. Even so, this may not translate to better pain control. Some studies have shown that a combination of hydrocodone and acetaminophen is just as effective at treating pain as oxycodone with acetaminophen.

Is tramadol stronger than hydrocodone? ›

As tramadol is less potent, doctors may prescribe it for slightly milder pain. They will generally only recommend hydrocodone if someone has severe pain that they cannot manage with tramadol or other weaker opioids. Hydrocodone and tramadol usually come in the form of a pill.

What injections are given for pain? ›

5 Common Pain Injections and How They Work
  • Facet joint injections.
  • Epidural steroid injections.
  • Sacroiliac joint steroid injections.
  • Selective nerve lumbar sympathetic block.
  • Transforaminal epidural injections.

What is an acceptable pain score? ›

Here, 0 means you have no pain; one to three means mild pain; four to seven is considered moderate pain; eight and above is severe pain. Pain scales are based on self-reported data — that means from you, the patient — so they are admittedly subjective. Your version of a seven could be someone else's idea of a three.

What is the most important part of a pain assessment? ›

The most important factor in pain assessment is the self-report of the patient. However, some patients may be reluctant to trigger the assessment so it is vital for nurses to prompt discussion of pain with patients.

What is the gold standard for pain assessment? ›

A Numerical Rating Scale (NRS) ranging from 0 to 10 (0, no pain; 10, maximum pain), which is based on a patient's self-report, is the gold standard for pain evaluation in patients who can communicate their pain intensity.

How do you prove chronic pain? ›

What tests are used to diagnose chronic pain?
  1. Blood tests.
  2. Electromyography to test muscle activity.
  3. Imaging tests, such as X-rays and MRI.
  4. Nerve conduction studies to see if your nerves are reacting properly.
  5. Reflex and balance tests.
  6. Spinal fluid tests.
  7. Urine tests.
1 Sept 2021

When is chronic pain too much? ›

Chronic pain is different. Your body keeps hurting weeks, months, or even years after the injury. Doctors often define chronic pain as any pain that lasts for 3 to 6 months or more. Chronic pain can have real effects on your day-to-day life and your mental health.

What is moderate pain? ›

Moderate Pain – Interferes significantly with daily living activities. 4 – Moderate pain. If you are deeply involved in an activity, it can be ignored for a period of time, but is still distracting. 5 – Moderately strong pain.

How do you break a pain management contract? ›

First, the patient can fire the physician for any reason, at any time. Second, the patient can complete the course of treatment, thereby ending his or her need for medical care. Third, the physician and patient can mutually agree to terminate the relationship.

What are the red flags for low back pain? ›

These “red flags” include a history of trauma, fever, incontinence, unexplained weight loss, a cancer history, long-term steroid use, parenteral drug abuse, and intense localized pain and an inability to get into a comfortable position.

How do you know if a patient is drug seeking? ›

Patients often reveal their drug habits through their behavior. They tend to be obsessive and impatient, calling repeatedly both during and after office hours. They manage to find physicians' home phone and pager numbers. They often do not keep follow-up appointments and then call for an immediate appointment.

Can I check my own Pdmp? ›

PDMP Reporting

In 30 states, patients have the right to view their own PDMP record. Some states allow pharmacists and other licensed health care professionals as delegates to check the PDMP for the physician.

Which might be considered a red flag on a controlled substance prescription? ›

Some of these “red flags” include: Prescriber writes significantly more prescriptions for controlled substances than other prescribers in area. Patient returning too frequently to receive additional medication. Patients presenting prescriptions for antagonistic drugs, such as depressants and stimulants, at the same ...

Can a pharmacist override a doctors prescription? ›

If you find that a drug your doctor prescribed is not working for you, a pharmacist cannot override a doctor's prescription. You should see your doctor and have a discussion about the medications you are taking. It's important to understand why your doctor prescribed a particular type or brand of drug.

What happens if you break a pain management contract? ›

If you violate the rules within a pain contract, you may be blacklisted by your doctor, and will most likely no longer receive any medication from them. In turn, you'll also have a much harder time finding a doctor willing to take you on as a patient.

Why is my doctor sending me to pain management? ›

A pain management doctor treats sudden pain problems such as headaches and many types of long-lasting, chronic, pain such as low back pain. Patients are seen in a pain clinic and can go home the same day.

Can my doctor just stop my medication? ›

Yes, your doctor can stop treating you for any non-discriminatory reason.

Which is the best pain killer injection? ›

Butorphanol injection is used to relieve moderate to severe pain. Butorphanol injection is also used to relieve pain during labor and to prevent pain and decrease awareness before or during surgery. Butorphanol is in a class of medications called opioid agonist-antagonists.

What painkiller is best for arthritis? ›

NSAIDs are the most effective oral medicines for OA. They include ibuprofen (Motrin, Advil) naproxen (Aleve) and diclofenac (Voltaren, others). All work by blocking enzymes that cause pain and swelling.

How long can you take painkillers for? ›

Painkillers containing codeine should only be taken for three days at most without medical advice. Taking other over-the-counter drugs for longer than ten days without guidance from a healthcare professional, could increase your risk of side effects such as problems with your stomach, heart, liver, or kidneys.

Is OxyContin still on the market? ›

Purdue Pharma, the maker of OxyContin, said it will no longer market the drug to doctors. The announcement comes in response to lawsuits that blame the company for helping to trigger the opioid crisis, CBS News reports.

How much hydrocodone is too much? ›

While the amount of hydrocodone that it takes to overdose varies for everyone, doses of 50 mg or more carry an increased risk of overdose. Doses of 90 mg or more are considered high risk; most doctors will never prescribe a dose this large, regardless of the situation.

How do I ask for the pain score? ›

Nurses can help patients more accurately report their pain by using these very specific PQRST assessment questions:
  1. P = Provocation/Palliation. What were you doing when the pain started? ...
  2. Q = Quality/Quantity. What does it feel like? ...
  3. R = Region/Radiation. ...
  4. S = Severity Scale. ...
  5. T = Timing. ...
  6. Documentation.

What are some follow up questions that you can ask the patient about their back pain? ›

15 Questions to Ask Your Doctor About Back Pain
  • What is causing my back pain?
  • Can some serious conditions be causing my back pain? ...
  • What will worsen my back pain? ...
  • Can stress be a factor? ...
  • What are my treatment options?
  • Are there things I can do at home or in my life to reduce my back pain?
27 Sept 2021

Why is my doctor sending me to pain management? ›

A pain management doctor treats sudden pain problems such as headaches and many types of long-lasting, chronic, pain such as low back pain. Patients are seen in a pain clinic and can go home the same day.

What are barriers to managing pain? ›

The [Institute of Medicine] committee [has] identified several important barriers to adequate pain care in the United States. These include the magnitude of the problem, provider attitudes and training, insurance coverage, cultural attitudes of patients, geographic barriers, and regulatory barriers.

What is the most reliable indicator of pain? ›

Abstract. Self-report of pain is the single most reliable indicator of pain intensity.

What is classed as severe pain? ›

Severe pain is defined as pain that interferes with some or all of the activities of daily living. May cause bed confinement or chair rest because of the severity. Typically doesn't go away, and treatment needs to be continuous for days, weeks, months, or years.

How much pain is too much pain? ›

Severe Pain.

When it intensifies to level 8, pain makes even holding a conversation extremely difficult and your physical activity is severely impaired. Pain is said to be at level 9 when it is excruciating, prevents you speaking and may even make you moan or cry out. Level 10 pain is unbearable.

What are the red flags for low back pain? ›

These “red flags” include a history of trauma, fever, incontinence, unexplained weight loss, a cancer history, long-term steroid use, parenteral drug abuse, and intense localized pain and an inability to get into a comfortable position.

Which of the following symptoms suggests a more serious cause of back pain? ›

If your back pain is accompanied by any of the following symptoms, head to your closest emergency room because you could be dealing with a more serious condition or injury: Sudden spike in pain, discomfort, weakness or numbness. Loss of bladder function. High fever.

How much of chronic pain is psychological? ›

Approximately 1/2 to 2/3 of all patients diagnosed with chronic pain manifest to various levels of psychological distress.

Will chronic pain ever go away? ›

Chronic pain usually doesn't go away, but you can manage it with a combination of strategies that work for you. Current chronic pain treatments can reduce a person's pain score by about 30%.

Can a doctor refuse to give you pain medication? ›

Know your rights!

As someone with a diagnosed, painful condition, your care team has a moral and ethical obligation to help you. In saying this, your physician can refuse you pain medication or deny you as a patient.

What are three major barriers to effective pain management? ›

Lack of knowledge about opioids, negative attitudes toward prescribing opioids, and inadequate pain-assessment skills combine to create major barriers to pain relief.

What is uncontrolled pain? ›

Neurology Pain that doesn't respond to medications at doses that usually provide appropriate analgesia.

What is effective pain management? ›

Key pain management strategies include: pain medicines. physical therapies (such as heat or cold packs, massage, hydrotherapy and exercise) psychological therapies (such as cognitive behavioural therapy, relaxation techniques and meditation)


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