In 1994, the Medical Board of California formally adopted a policy statement titled, “Prescribing Controlled Substances for Pain.” The statement outlined the board’s proactive approach to improving appropriate prescribing for effective pain management in California, while preventing drug diversion and abuse. The policy statement was the product of a year of research, hearings and discussions. If your doctor practices in California, they will most likely use these guidelines to help provide safe use of opioid therapy as part of your treatment plan. You will also be responsible to abide by these guidelines and all DEA, state and federal regulations. If you are in a state other than California check your government website for these guidelines pertaining to your state. To review these guidelines in detail go to “Prescribing Controlled Substances for Pain”.
Before prescribing you medications your physician will perform a complete medical history and physical examination. This will include an assessment of your pain, your physical and psychological function, a substance abuse history, a history of prior pain treatment, an assessment of underlying or coexisting diseases or conditions, and documentation of the presence of a recognized medical indication for the use of a controlled substance. It is important that you be honest and provide as much information as possible to your physician. You must have a reasonable medical need and indication to be prescribed opioid therapy to manage your pain. As stated before, it is your responsibility to bring your past medication records, including any lab or imaging studies, and a list of your current and past medications (as well as the original bottles) to your initial doctor visit.
During your follow up visits, your physician will be looking for objectives by which the treatment plan can be evaluated, such as pain relief and/or improved physical and psychosocial function. He or she will determine if any further diagnostic evaluations or other treatments are needed. Your physician will tailor pharmacological therapy to your individual medical needs.
Multiple treatment modalities and/or a rehabilitation program may be necessary if your pain is complex or is associated with physical and psychosocial impairment. When discussing your care with your physician, it is important that you not focus on your “pain scores”, but rather on any improvement in physical and/or psychosocial function.
Your physician will also review the risks and benefits of the use of controlled substances and discuss other treatment modalities with you (most of this information is also provided in this tutorial). It is your responsibility to ask questions if something is unclear and to request additional information for a more thorough understanding.
The physician will periodically review the course of your pain treatment, considering any new information about the etiology of your pain and the state of your health. If your progress is unsatisfactory, your physician may assess the appropriateness of continued use of the current treatment plan and consider the use of other therapeutic modalities.