A pain management agreement is a contract between you and the pain team. It is meant to help you manage pain and set limits for safe care.
Serious illness and its treatment can cause pain. Pain may be caused by:
Tests, treatments, or treatment side effects
Disease or surgery
Nerve damage or inflammation
Chronic conditions
If you have chronic pain due to a serious illness, you may be prescribed pain medicines called controlled substances. Examples of these strong medicines are opioids. These medicines must have safety limits to ensure proper use and avoid harm to you and others. Harm may come from:
Taking too much of a prescribed medicine
Taking too little of a prescribed medicine
Stopping a medicine too quickly
Sharing medicines with others
Mixing different substances
Becoming dependent on a medicine or taking it for too long
When prescribing pain medicines, the pain team will ask you to sign a pain management agreement. By signing this agreement, you agree to follow its rules. If you break a rule, the pain team could end your pain management agreement and stop services.
Common parts of a pain management agreement
A pain management agreement may include information on:
Your pain clinic and the pain team
Your rights and responsibilities as a patient
The importance of keeping appointments and bringing medicines to appointments
Pain medicine’s effect on unborn babies
The agreement may include rules about:
Medicine changes and refills
Keeping the pain team informed of any side effects and changes to symptoms or clinical status
Restrictions on receiving prescriptions for pain medicines from outside medical providers
Substance use safety and risks
Required drug assessments
You will be asked to agree to the rules listed in the agreement. At the end of the agreement, there will be a place to sign your name. If you are under 18, there will be a place for a parent or guardian to sign.
Your pain clinic
Your pain care team works with you and your primary care team to manage pain problems. The pain clinic may offer:
One-time consults to assess pain and make a plan for managing it
Long-term follow-ups (as needed) to ensure the pain management plan works for you
Members of the pain team will:
Meet with you
Make a plan of care
Communicate the plan with you and your primary care team
Check on your response to medicines in the hospital or in an outpatient setting
Help you to meet your pain management goals safely
Your pain care team
The pain care team uses different ways to manage pain because pain can affect your body, mind, and daily life. You will meet with a team of experts who work together to help you feel better.
The team may include:
Anesthesiologists – doctors trained to manage pain and give anesthesia
Nurses – members of the care team who play a central role in every aspect of patient care
Advanced practice nurses – nurses with advanced education and clinical training
Psychologists – doctors trained to assess mental well-being and provide counseling. They can also identify coping skills that help you manage pain without medicine.
Child life specialists – care team members who help patients cope with medical procedures and support patients and families during treatment
Physical therapists – care team members trained to help patients improve their physical movement and manage pain
Pharmacists – care team members trained to get patients the right medicines and make sure they understand how to use them
Pain management may be offered to patients who are in the hospital and those who are outpatients.
What to expect from the pain team
Members of the pain team may ask you to rate your level of pain, to rate how much you are able to do daily activities, and to keep a pain diary. The team may use topical medicines (placed on the surface of the body) and patches to help with localized pain.
Physical methods to manage pain may include heat, ice packs, massage, or exercise.
The pain team may use other ways to help you manage pain without medicine, such as talk therapy, visualizing peaceful scenes, relaxation, or other therapies.
Patient responsibilities and expectations
Patient responsibilities under the agreement may include the following.
Taking medicines as prescribed
Take medicines exactly as prescribed by the pain team. The medicines may include opioids, anti-inflammatory medicines, and medicines to treat nerve pain.
Do not share your medicine with anyone or take pain medicines not prescribed to you. Talk to the pain team before stopping any medicine.
Appointments
Bring all your pain medicines in their prescription bottles and pill boxes to each appointment. This helps ensure that you have enough medicine.
Keep all appointments and arrive on time. If you need to reschedule or will be late, call your pain team.
Changes, refills, and reporting
Tell the pain team about any side effects or if you feel the need to change the amount of medicine prescribed.
Request refills during regular clinic hours. Lost or destroyed medicines will not be refilled early.
Pick up your medicines at the pharmacy that you and your pain team agree upon, not at other pharmacies.
Check with the pain team before using any over-the-counter pain medicine.
Keep medicines in a secure place, out of children’s reach.
Outside providers
While under the pain care team’s care, do not get pain medicine from other providers. Changes to your dose or adding new pain medicines require the pain team’s approval.
Pain team responsibilities and expectations
The pain team’s responsibilities are to:
Understand your health history
Ensure safe use of medicines
Understand what is causing your pain and your medical history
Make sure that pain medicines are right for you
Explain your medicines and the agreement clearly
Explain how the medicine works and any side effects or risks
Offer other ways to help with pain, like exercise, physical therapy, or counseling
Make sure you understand and follow the pain management agreement
Create a treatment plan
Make a plan for medicines, health goals, and other pain treatments
Help you set wellness goals that you can achieve and that will help you reach your pain management goals
Check in regularly with you and keep a record of your pain management plan
Prescribe and watch medicines carefully
Make sure the prescription, the dose, and timing are right for you
Research to make sure that you are not getting other pain prescriptions from other providers or pharmacies
Do drug screenings to make sure you are using your medicines in the right way
Ask you to bring your medicines to your appointments so that they can make sure you have enough medicine
Work together and communicate
Talk with you and your other care providers
Work together with your primary care team and other medical specialists
Refer you to a medical specialist if needed
Act if rules are not followed
Take action if you do not follow the agreement. This could be changing the pain care plan, helping you to stop the medicine safely, or ending the pain management agreement.
Tips to be successful with your pain management plan
Follow the pain team’s instructions. Take medicines exactly as prescribed, keep your appointments, and bring all your medicines to appointments.
Talk to the pain team before stopping any medicines. Stopping a pain medicine suddenly can cause severe side effects. The pain team can make a plan for you to decrease the medicine slowly.
Tell the pain team about any side effects or concerns as soon as they come up.
Keep medicines locked and out of reach of children.
Do not share medicines with others. There are both legal and safety risks to sharing prescriptions.
Do not smoke, drink alcohol, or use THC (tetrahydrocannabinol), which is the chemical in marijuana that causes a “high.” These substances can interact with pain medicines and may break your pain management agreement.
Use ways to manage pain without medicine, such as meditation, massage, and physical movement along with taking your medicines as prescribed.
What are violations to the pain management agreement?
Violations to your pain management agreement may include:
You get pain medicines from a provider other than your pain team.
Another provider changes your pain medicines without talking to your pain team or getting approval.
You request to change your pain plan or request medicine refills after regular business hours.
You request an early refill of medicines.
You do not bring the pain medicines you are taking to your scheduled pain clinic appointment.
You miss your scheduled pain clinic appointment.
You are more than 30 minutes late to your scheduled appointment and do not call.
You do not take your medicines as stated in the pain plan.
You report that you lost or accidentally destroyed your supply of a pain medicine prescription.
Someone other than you takes your prescribed medicine.
You take pain medicines or other controlled substances that were not prescribed to you.
You use illegal substances while taking your pain medicines.
An unforeseen risk (such as a car accident) happens that poses serious harm to you or other people.
You test positive for prescription medicines that were not prescribed to you.
You test negative for medicines that were prescribed to you when you told the pain team that you were taking them.
What happens if you break the pain management agreement?
If you break your pain management agreement, the pain team may talk to you about it or give you a warning. After a certain number of warnings, the pain team may end the pain management agreement and stop treatment with pain medicines.
After a violation, other things the pain team may do are:
Lower the dose of a medicine or change to a different kind of treatment
Add more appointments or drug screenings to your schedule
Stop prescribing pain medicines
Create a plan to slowly reduce the amount of medicine you take
Refer you to a specialist or to treatment for substance use
The goal of this care is to keep you safe and find the best ways to manage your pain. You will still get the medical care that you need for your condition.
What happens if you are dismissed from your pain clinic?
The pain team will let you know before you are dismissed from your pain clinic.
The pain team will work with your primary care team to make a supportive plan and give guidance on next steps.
Questions to ask the pain team
What is a pain management agreement?
What medicines are covered under this agreement?
What are the risks of these medicines?
How long does the agreement last?
Am I allowed to take over-the-counter medicines along with my pain medicine?
What if I need emergency care?
What happens if I do not follow the agreement?
How can I manage my pain without medicine?
How does this agreement support my overall health?
Key points about pain management agreements
A pain management agreement is a 2-way agreement between you and your pain team. You agree to follow certain rules, and the pain team agrees to provide care and support for your pain needs.
The agreement is to ensure your health and safety when taking strong pain medicines.
It is important to follow your pain management agreement for effective and safe pain management.
The pain agreement includes rules about taking medicines as prescribed, going to all scheduled appointments, not sharing medicines with others, and drug screening.
If you violate the agreement, the pain team may change your treatment plan or end the agreement.
The goal of the agreement is to help you manage your pain in a safe way.
