Risk Management Tools & Resources


Using Pain Management Agreements as a Tool to Promote Patient Adherence to Treatment


Patients who suffer from chronic pain can be challenging to successfully treat. In addition to finding the optimal course of treatment, issues related to patients adhering to treatment plans can be problematic. Thus, healthcare providers who prescribe pain medications might want to consider using pain management agreements to set standards and expectations related to care and treatment and to reinforce the importance of following treatment regimens.

Developing Pain Management Agreements

Pain management agreements should be specific and directly related to the patient’s pain management plan/program. Providers also might want to incorporate specific statements about behaviors to avoid. Some examples of expectations to incorporate into a pain agreement include the following:

  • I agree to follow the terms of this document. I understand that if I don't follow the terms, my provider will stop prescribing me controlled-substance medications.
  • I agree to seek psychiatric treatment, psychotherapy, and/or psychological treatment if my provider feels it is necessary.
  • I will not use any illegal controlled substances (e.g., heroin), and I will not misuse or self-medicate with legal controlled substances.
  • I agree to take a drug test upon request.
  • I will bring all my unused medication to office visits.
  • I will not share my medication with anyone.
  • I will store my medication in a secure location to prevent it from being lost, stolen, or unintentionally used by others.
  • I understand that my provider will consider replacing stolen medication only if I complete a police report. OR — I understand that lost or stolen medications will not be replaced.
  • I will not attempt to obtain any controlled-substance medications — including opioid pain medications, controlled stimulants, or anti-anxiety medications — from any other provider.
  • I understand that my provider may contact community resources (e.g., pharmacies, law enforcement agencies, etc.) to ensure that I am following my medication treatment plan.

If applicable, agreements should address any state requirements related to pain management or controlled substance agreements. Additionally, the provider should designate the specific pharmacy where the patient must fill or refill all prescriptions. If a patient does not follow a pain agreement, the healthcare provider should consider terminating the provider–patient relationship.

Considering Other Pain Management Issues

As part of pain management processes, healthcare providers also might want to:

  • Consider when they or their staff members are able to address refills (e.g., only at the time of a visit or during regular office hours).
  • Define appropriate use of alcohol as part of the pain management agreement, such as “Have no more than [x] number of alcoholic drinks per timeframe, and do not drive or operate machinery.” Providers might need to prohibit the use of alcohol for some patients.
  • Consider creating a patient rights and responsibilities policy specific to pain management. By doing so, providers can reference that resource within the pain management agreement and decrease the length of individual agreements.
  • Review state-specific reporting requirements.

Presenting Patients With Pain Management Agreements

Presenting patients with pain management agreements might be difficult or uncomfortable. Healthcare providers should ensure that they and their staff members are prepared for the process. Patients may react differently to pain management agreements. Some might accept it with understanding, while others might push back or become hostile. Providers and staff members should be knowledgeable about organizational procedures for handling hostile and aggressive patients and visitors.

Prior to presenting a pain management agreement, the provider should consider what to say to the patient. Role-playing exercises can be an effective way to practice presenting pain management agreements and to test procedures for handling hostile behavior.

When discussing a pain management agreement with a patient, the provider should be firm, yet appropriately compassionate. The provider should emphasize that patient care is a team effort, and make it personal by highlighting the team members — the doctor, the patient, the staff, etc. It might be helpful to explain to the patient that all team members must work together effectively to ensure appropriate and safe care and to maintain the provider–patient relationship.

To avoid catching the patient off guard, the provider should consider sending the pain management agreement with a cover letter explaining its purpose to the patient before the next appointment. This gives the patient (as well as caregivers and/or family members) time to absorb the concept and consider any potential questions.


For more information see MedPro’s Risk Resources: Opioid Prescribing & Pain Management.

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