Some pain management clinics ask people to sign contracts that outline what the clinic expects from them. Some clinics may discharge people if they breach the contract. The exact number of chances depends on the clinic and doctor.
Pain management contracts aim to prevent the misuse of pain medications, such as opioids.
Not all pain management clinics or doctors use these contracts. Those that do can have different rules, so a person should check their contract if they have signed one.
Read on to learn more about how many chances people get at pain management, including pain management contracts, what can happen if someone breaks the contract, and what the options are if the clinic discharges them.
Whether a person has a limited number of chances at a pain management clinic depends on the facility or doctor who is treating them.
Some clinics use pain management contracts to try and prevent drug misuse, but the rules in these contracts can vary.
Medical News Today reached out to Rainier Guiang, MD, co-founder of University Pain Consultants, a pain management practice in Southern California, for his perspective.
“In our contract, we make it very clear that any breach may result in the immediate termination of the doctor-patient relationship,” said Guiang. “This is regardless of the amount of medication the person is on and whether or not they will have severe withdrawal effects from stopping the medication suddenly.
“Our clinic only enforces termination for the most serious of breaches, such as concurrent use of dangerous street drugs. Conversely, for minor breaches of the contract, such as slight overuse of their medication, we generally give three warnings,” he said.
Guiang explained that policies concerning the number of chances are not standard among pain management clinics.
“I have seen local doctors dismiss people for having urine drug tests that showed a minimal amount of alcohol,” he said. “And this is the first offense. On the other side of the spectrum, there are doctors who barely ever drug test anyone. In terms of how many chances someone gets, it is up to the discretion of the doctor to decide.”
In regard to people who have not signed a contract, Guiang’s clinic generally does not prescribe opioid medications.
“At times, we will provide a limited course of medication without requiring an opioid contract,” explained Guiang. “This can happen if we know that the duration of treatment is short, such as postoperative pain for a minor procedure.”
According to a 2016 research article, professional societies, medical licensing boards, and many state officials urge the proactive monitoring of opioids.
Sometimes this monitoring takes the form of a written agreement, also known as a narcotic contract or pain contract.
The purpose of the contracts is to address the risk of opioid overdose and death. Even when someone uses opioids appropriately, there is a risk of:
- motor vehicle accidents
- unintentional overdose
Another purpose of the contracts involves preventing the use of prescription opioids for nonmedical use.
In these contracts, the doctor and patient agree to conditions under which a doctor will prescribe or discontinue opioids. A
- information about the risk of opioid tolerance and dependence
- a mandate that only one doctor prescribes and only one pharmacy dispenses the drug
- prohibition of increasing the dose or frequency of the opioid
- statement that a doctor cannot replace stolen or lost prescriptions
- notation of what assessment for compliance the doctor will use, such as urine drug screening
The Food and Drug Administration (FDA) provides an
What happens depends on what the contract says and the clinic’s or doctor’s approach to treatment. In some cases, the doctor-patient relationship may end, and the doctor may discontinue the pain medication.
“A standard practice amongst all reputable pain clinics involves testing for the most common harmful street drugs on the first visit,” said Guiang.
“If the test is positive and an additional test confirms it, we generally will either refuse to prescribe or will discontinue prescribing opioid medications for that individual. We usually will retest once a year for most people or as needed if there is suspicion of questionable behavior,” he explained.
If a person breaches the contract, the clinic or doctor may discharge them. However, there may be other options for pain management.
After discharge, a person at Guiang’s clinic can either receive non-opioid pain medication, go to a drug rehabilitation clinic, or try another pain management doctor.
“If someone breaks their opioid contract to the point where we will discontinue all opiate medications, we will offer conservative, non-opioid therapies only,” said Guiang.
“This means we would be willing to continue non-opioid medications and procedures for pain relief. An example may involve nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin).”
When people are not agreeable to this, Guiang’s clinic may provide resources for local drug rehabilitation centers to contact.
“Another option entails referring them to another pain management doctor of their choice,” he said. “That said, it will be completely up to the discretion of the new pain management doctor to decide whether they are willing to take on the individual.”
Different parts of Medicare provide coverage of pain management that is medically necessary, but a person is responsible for copayments, coinsurance, and deductibles.
In original Medicare, or Part A and Part B, someone may purchase a Part D plan for prescription drug coverage. This helps pay for opioid pain medication and medication management programs for people with complex health needs.
In addition, for most pain management services, original Medicare covers part of related doctor visit fees under Part B, which deals with outpatient services. Part B also covers nonmedication services that can help manage pain, such as physical therapy and acupuncture.
If a person receives pain management while in a hospital, original Medicare covers it under Part A, which deals with inpatient services.
Instead of original Medicare, some people have an Advantage plan, which is Part C. This provides all the coverage of Medicare parts A and B. Most Advantage plans also include a prescription drug coverage plan, which would cover pain management.
A 2014 study estimated the cost of a 30-day supply of opioid medication based on 2000–2007 data. Researchers found the average cost per person was $251. The study based the estimates on the three lowest manufacturer prices that Red Book 2009 listed.
Pain management contracts are agreements between a doctor and a person seeking pain medication that lists the responsibilities of both parties. In some contracts, there may be rules about how many times a person can breach the contract before the clinic or doctor discharges them.
The number of chances a person gets at pain management varies among clinics. Some clinics will discharge someone after a major breach in an opioid contract and issue warnings for more minor violations. Usually, doctors test for harmful drug use once per year to gauge compliance.
If a person breaches a pain management contract, they may get further chances at the clinic or have to stop taking their medication. Depending on the clinic, the person may receive non-opioid pain medications or go to another pain management doctor.