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.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.