Thursday, March 18, 2010

Pain Contracts for Opioids

Rosemary Flanigan
March 18, 2010

In 2009, the FDA announced that they would require the manufacturers of opioids to come together and develop a single Risk Evaluation Mitigation Strategy (REMS) and further suggested that “pain contracts” might be required as a component of such.

Our Myra Christopher has expressed serious ethical concerns about the universal application of pain contracts although they are growing in popularity among physicians.

Recently, the Center collaborated with the American Academy of Family Physicians to develop a CME program on the treatment of chronic pain for their AAFP LIVE! Initiative. Over the past few months, Myra has helped at five conferences across the country to deliver this curriculum. Approximately 1500 providers attended.

The use of pain contracts is raised in the curriculum and has been a point of discussion at all five conferences although there is NO data that points to the efficacy of these contracts. And the only legal action that has resulted from their use has been an action against a physician for not following the terms of the agreement.

Although Myra believes that these documents can be helpful in the care of complex chronic pain cases when the patient has difficulty managing their medications, she is very concerned about their universal application and believes they are corrosive to the therapeutic relationship between the provider and patient.

Her fundamental concern is that these contracts shift the locus of concern from the patient to the provider and violate the covenant between the healthcare professional and the pain patient.

Would you, my thoughtful discussion participants, express your judgments regarding these pain contracts?



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