The Pain Contract: A Doctor-Patient Pain Treatment Agreement

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.1
  • 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.1
  • Improves treatment plan adherence. Understanding how and why opioids are being prescribed often helps patients adhere to their treatment plans.1

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:
Further Reading: Acute vs. Chronic Pain