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Massachusetts Board of Registration in Medicine
Management of Pain
Pain is one of the most common reasons people consult a physician, yet it frequent is inadequately treated, leading to enormous social cost in the form of lost productivity, needless suffering and excessive healthcare expenditures.
American Pain Society, The Use of Opioids for the Treatment of Chronic Pain
The Board does not wish to discourage physicians from prescribing strong analgesics to relieve the suffering of patients who are in severe pain, both acute and chronic. Opiates and opioids have legitimate clinical usefulness, and physicians should not hesitate to prescribe them when they are indicated for the comfort and well-being of patients who require relief that cannot be provided by non-opiate analgesics and alternative forms of therapy.
When faced with a patient who is in acute or chronic pain physicians should complete a history and physical that addresses the nature of the patient’s pain and includes an assessment of the patient’s risk of addiction. Physicians should consider and explore appropriate alternatives to drug therapy and referral to an established pain clinic. Neuropathic pain is usually not relieved by the use of narcotic analgesics and physicians should look for drugs that have been shown to be effective for that particular symptom. The treatment plan should be individualized to the patient. The medical record should include documented, careful informed consent and possibly a written agreement signed by the patient. Periodic reassessment and review of the treatment plan should be well-documented.
The Board also recognizes that there is a distinction between prescribing solely to maintain a dependency and prescribing to chronic pain patients who are tolerant to the pain medications they require. All patients will probably develop tolerance and physical dependence with sustained use of narcotic and analgesics. When patients are receiving these drugs for the treatment of legitimate pain, this rarely presents a problem.
Beyond these basic principles of pain management, the Board has specifically endorsed the Model Guidelines for the Use of Controlled Substances for the Treatment of Pain that were developed and adopted as policy by the House of Delegates of the Federation of State Medical Boards of the United States, in May 1998. These Guidelines are appended as Attachment B.