When opioids are prescribed for an extended period of time, such as in cases of chronic pain, a doctor may require a patient sign a pain contract, sometimes called a pain treatment agreement.


There is not a standardized agreement, however, most agreements will focus on the following:

  • Only getting pain medications from one doctor
  • Keeping the medication stored safely and securely
  • Taking the medication as instructed
  • Scheduling, and keeping, regular appointments
  • Using the same and agreed upon pharmacy for refills
  • Refraining from illegal drugs and/or alcohol
  • Submitting to drug testing, if asked

The pain contract is an agreement that may result in expulsion from a pain management program if broken. It also acts as a communication tool between the doctor and patient.

Although it may be intimidating, a pain contract can be used as a forum for conversation about the risks and benefits of a pain management program.

  • Provides an opportunity to voice concerns. The side effects and risks associated with opioid use are likely to elicit concern from a patient perspective.7
  • Strengthens the doctor-patient relationship. A strong relationship between doctor and patient increases the likelihood of a successful treatment program, and a treatment agreement allows expectations from both sides to be discussed.7
  • Improves treatment plan adherence. Understanding how and why opioids are being prescribed often helps patients adhere to their treatment plans.7

Additionally, when discussing a pain treatment agreement, a patient can ask the doctor about complementary and alternative medicine (CAM) and other techniques to use with opioids.


  1. Center for Substance Abuse Treatment. Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2012. (Treatment Improvement Protocol (TIP) Series, No. 54.) 5, Patient Education and Treatment Agreements. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92049/.
Further Reading: Acute vs. Chronic Pain