The Pain Treatment Contract
Posted by Ellen—April 21st, 2013

While Migraine is a neurologic condition that involves pain, and is not a pain condition, patients sometimes end up on narcotic or other therapies that utilize controlled substances. While this is typically appropriate in only a few situations, when it does happen it is not at all unusual for patients to be asked to sign a pain treatment contract with their doctors.

What is a pain treatment contract?

A pain treatment contract may be presented to the patient under many different names, but the concept is the same…

Patients may need narcotic or other therapy utilizing a controlled substance, and doctors need to be sure that the patients are getting the benefit from this therapy. A contract between physician and patient helps to facilitate treatment utilizing controlled substances and serves as an agreement between the two parties that everyone will be following a specific set of rules. As such, it eliminates misunderstandings between patient and doctor.

Why do I need to sign a pain treatment contract?

Controlled substances may be misused or diverted by doctors, patients, family and friends. The illegal use of prescription pain killing medicines has hit an all time high recently, and there has been serious discussion within the powers-that-be concerning stricter limitations of controlled pain medications that will limit the ability for doctors to treat some of their sickest patients effectively. Many doctors consider these stricter limitations to be against the best interests of chronic pain patients.

Both doctors and patients are too often the collateral damage in the war against drugs because they are openly utilizing these medicines and are easy to find by simply opening a phone book. These contracts are not necessarily what your doctor wants, but he/she also doesn’t want to lose their ability to prescribe these medicines to their patients who need them, nor to lose their lifelong vocation and passion — the practice of medicine. Pain treatment contracts protect doctors and their patients. Doctors who routinely prescribe pain medicine ask nearly all their pain patients to sign these documents, so assuming they think you are a drug addict or dealer is simply incorrect.

What is in a pain treatment contract?

Rules may vary from one contract to the next, but the general idea of a pain treatment contract is that you are agreeing to let this particular doctor take complete control over all your pain control needs. Your signature usually indicates that you agree not to ask other doctors for prescription pain control medicines. You usually agree to use a single pharmacy for all your medicines — especially your pain control medicines. You are often agreeing to submit to random drug screening so your doctor can be sure that you are taking your medicines the way you are supposed to take them, and not abusing others. You agree not to ask for additional prescriptions, or take doses at times other than they have been prescribed. It is an understanding that if your meds are lost, damaged or destroyed they will not be replaced. You agree not to give away, share or sell your medicine. It also may explain in writing that dependency may occur and that side effects of withdrawal may occur if you stop taking your medicine for any reason.

What if I disagree with my contract?

Most physicians have a formal contract they ask most if not all of their patients to review and sign. You may have questions about your contract. Staff expects these questions and will help you with as many answers as they can. Other answers may be gotten by talking directly to your doctor. You may be under the care of another physician who is already prescribing controlled substances that may or may not be narcotic in nature. Coordination may be necessary between the two physicians to assure you are receiving appropriate care. This may take some time and most doctors are understanding of that and will work with you. The contract is a basic form and need not necessarily be signed as written. When extenuating circumstances are present, additions to and deletions of certain parts of the contract may be necessary.

Do I have to sign my contract?

Most doctors who deal with chronic pain expect you to sign a pain treatment contract of some type. Whether or not they will treat you without that contract is entirely up to them. Remember, they are asking you to sign the contract to protect everyone and prevent misunderstandings. In fact, having these contracts in place for all pain patients helps the case for keeping government regulations over controlled substances low, so signing the contract benefits the entire community of pain patients.

Why doesn’t my Migraine specialist ask me to sign a contract?

Migraine and headache specialists sometimes prescribe controlled substances like Demerol, Percocet or Lyrica to their patients, however, because of the risk of medication overuse headache, it is unusual for pain treatment medicines to be prescribed for daily use. Remember, Migraine is a neurologic condition that may or may not have the symptom of pain to accompany it. The goal of a specialist is to help you get better management over your Migraines and use abortives to stop an attack, not simply cover up a symptom and hope the attack is gone by the time the pain medicine wears off. If the medicine is a preventive like Lyrica, you may be required to sign a contract.

My pain contract

The staff of my rheumatologist has asked me to sign a pain contract. I am on no daily controlled substances however, so if the day comes when I need that type of treatment, I will sign it after having a discussion with him about my particular circumstances of utilizing multiple specialties and physicians. I prefer the pain contract to fighting with my doctors over every prescription refill, as I have had to do in the past when there was no contract in place.

What does a pain contract look like?

A pain treatment contract is a very basic document, very much like those you sign when you become a doctor’s new patient. In fact, it often is one of the documents you sign when you become a new patient. Click here to see an example: Pain Contract

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About Ellen

Migraine.com’s patient educator/advocate, writer and community leader Ellen, is a lifelong Migraineur. She has been chronic since the mid 1990′s.

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