Pain contracts can undermine patient trust.

A new article cautions that although the documents improve care when done right, an adversarial approach is "corrosive" to the doctor-patient relationship.
By Kevin B. O'Reilly
As the misuse of opioids has grown, more physicians have urged patients to sign so-called pain contracts in an effort to prevent medication diversion, but these contracts, also called opioid treatment agreements, can be used indiscriminately and harm rather than enhance the physician-patient relationship.It is not that any of us disagree with the notion that agreements can, in fact, be very helpful in certain circumstances,"It is noted that patients with a history of substance abuse or mental illness may be aided by documents that inform them of the risks and benefits of opioids and set out a care plan.
"But,"what is becoming common practice in many pain specialty clinics is using a preprinted, standardized form that says, 'If we're going to treat or prescribe controlled substances to you, these are the conditions under which we'll do so -- and sign this document, and if you fail to do so, then we'll fire you from our practice.That kind of adversarial approach is "corrosive to the relationship" and threatens patients in need with abandonment.Though pain agreements vary, they often involve urine screening for medication levels and specify the number and frequency of prescription refills. How physicians discuss the agreements with patients is critical."Just think about how it's presented -- unless you sign this, you won't get your medications," My doctor said that to me, it is crossing the line. ... It's basically a document that says, 'You do this, or I've gotcha.' That's basically interfering with what should be a trusting relationship between the patient and the practitioner."
Scope of the problem;
The American Academy of Pain Medicine, the American Pain Society and the Federation of State Medical Boards have recommended that physicians consider using opioid treatment agreements.
A written agreement, when used without coercion and for the purpose of promoting the patient's health, is in line with "fundamental ethical principles,"Many doctors, who are concerned about high-profile prosecutions of physicians treating patients with chronic pain, use the documents as a way to protect themselves legally while making clear to patients that they will not tolerate diversion -- a growing problem.
Doctors struggling to treat patients in pain while avoiding legal scrutiny should avoid the quick fix promised by one-size-fits-all pain contracts!
"I can fully understand why the primary care doctor will say, 'I don't want to be in trouble with the medical board. [Pain agreements] seem to be a trend, and then if I get asked by the medical board about this I can say, 'Look at all these contracts I have in my medical charts,
"But if the question is how do I best help my patients, how do I build trust with my patients, then that's a more complex proposition."
If the patient does not have a criminal background, or a history of drug abuse, then these contracts should not be pushed onto the patients!