Pain Contracts Threaten the Doctor-Patient Relationship

This is an article that I believe should be required reading for those of us who are taking pain medications that contain opioids, no matter how little is really in it. by Kevin Pho, MD Doctors today are wary about treating chronic pain. One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.” Requiring chronic pain patients to sign pain contracts is a way to mitigate this risk. But how does that affect the doctor-patient relationship? Indeed, a contract is an adversarial tool. Essentially, it states that a patient must comply with a strict set of rules in order to receive medications, including where and how often they obtain controlled substances, and may involve random drug testing. Break the contract and the patient is often fired from the practice. A recent perspective piece from The American Journal of Bioethics discusses its effects: “… what is becoming common practice in many pain specialty clinics is using a preprinted, standardized form that says, ‘If we’re going to treat or prescribe controlled substances to you, these are the conditions under which we’ll do so — and sign this document, and if you fail to do so, then we’ll fire you from our practice.’ ” That kind of adversarial approach is “corrosive to the relationship” and threatens patients in need with abandonment. To read the rest of this article please go to http://www.kevinmd.com/blog/2011/01/pain-contracts-threaten-doctorpatient-relationship.html#comment-153086