Patient contracts help physicians track pain medications

A study suggests a written agreement can be an effective tool, but that more structured drug-testing strategies are necessary.

By Victoria Stagg Elliott, AMNews staff. May 28, 2007.

Prescribing opioids for chronic pain is a delicate balance.

As a result, a patient could once again do the things he or she loves because the pain is no longer disabling. Or, that patient could become addicted. Some form of written care agreement or contract is among the tools most frequently used by physicians to try to guide the patient toward the more favorable outcome. Conclusive research is still lacking, but a recent study found that such contracts may have the desired effect, according to the April Journal of General Internal Medicine.

"This is a tool to be able to provide better care for patients who are on these drugs," said Dr. Jaishree Hariharan, lead author and associate professor of general internal medicine at the Medical College of Wisconsin.

Dr. Hariharan and her team followed for a five-year period 330 patients from a general internal medicine clinic who were in this situation. Out of the group, only 17% of the patients had their contracts cancelled, primarily because of substance abuse and other noncompliance problems. About 20% discontinued them voluntarily, and 63% were still following the rules laid out an average of nearly two years after signing.

Prescribing narcotics, particularly for those with chronic pain unrelated to cancer, has long been challenging for physicians. Legal and regulatory scrutiny are worries for doctors and are issues that have come up at numerous medical society meetings. The American Medical Association policy, for instance, supports balancing access to necessary pain medication with preventing drug abuse and diversion. The AMA's Council on Science and Public Health is also expected to issue a report on this subject at the organization's June meeting.