prescription of narcotic pain medication for chronic non-cancer pain

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there are guidelines for the prescription of narcotic pain medication, available from the federation of state medical boards. additionally, information is available from various manufacturers of narcotic pain medication, and i believe they all refer to the fsmb guidelines. one rule of thumb which i have added to my practice is that i require all patients on chronic pain medication to have an initial and yearly evaluation/re-evaluation at the pain clinic, no exceptions, as a condition of my care and continuing prescription of pain medication, in addition to periodic visits with me. if you have any chronic pain patients, first and foremost decide if you are going to prescribe for them. if you are not, refer to the pain clinic, and make it clear that ALL pain medication will need to be prescribed by the pain clinic, NO exceptions. if you are going to prescribe, follow the guidelines, and do not deviate

from them. be sure to use all of the appropriate tools for the documentation of chronic pain treatment, including patient history, pain diaries, pain agreement, and a clear understanding of the risks and benefits of narcotic pain medication use. above all, have a low threshold for specialty referral. any changes in the pain regimen require re-evaluation by the pain clinic; only prescribe if all of the above conditions apply, if the dose is stable, and if there are no adverse side effects. this is one area where black and white and sticking to the rules works really well. hope that's helpful. LL"Jerry Park, D.O." wrote: , I have tried for a long time to write down my own personal narcoticpolicy (I work in urgent care but am plotting an IMP), but haven'tbeen able to do it for whatever reason. I have some "typical" paincontracts as models to use, but like you I'm not really wanting to bein the chronic pain business at all. I might follow a few complicatedproblems for a year or rarely two, but not for "unlimited" time.Is your personal narcotic policy something you might share or no? It's one of my New Year's resolutions to write my own formal narcoticpolicy soon.I've been reading that the use of the "top five" narcotics used by thepublic (oxycodone, hydrocodone, codeine, morphine, and I can'tremember the 5th they consider to be "top five") has

more than doubledin the last 5 years in the U.S.. This is an issue that is not goingaway anytime soon.Jerry >> I knew that this was going to be an issue in my area when I started. I> made and published my rule: no chronic opioids or benzos. I explain> that they are difficult to administer and that my rule is part of> keeping my overhead low. I think that word is on the street now,> because I get fewer calls from people looking for this. I like the> patient population that I have built this way. Easier for me because I> rent space from a pain mgmt practice, and we share some patients.> > Getting there once you're already prescribing a lot of these is tough,> but it can be done.> > Mala, 700 patients

and not breaking even? I don't remember your> practice setup. What are your total expenses?> > Haresch

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