Recommendations for Managing Patients with Chronic Pain

By Tammie Smeltz, Content Marketing Manager

Chronic pain is an ongoing problem in the United States, and it is expected to worsen over time. According to a study from the National Institute of Health, chronic pain is diagnosed more often than other chronic conditions, such as diabetes and high blood pressure every year. Chronic pain is often difficult to diagnose and treat. The study found that two-thirds of patients who suffer from chronic pain still complain of pain the first year after diagnosis.

Furthermore, according to a recent study from the Centers for Disease Control and Prevention, an estimated 20.9% of adults in the United States experienced chronic pain in 2021. Activities of daily living were substantially reduced in 6.9% of the adults who participated in the study.

Some patients with chronic pain find treatment modalities like physical therapy, cognitive behavioral therapy, yoga and massage can reduce their pain. A recent study from JAMA Network Open even found that physician empathy is associated with better outcomes in patients with chronic pain.

However, despite a wide variety of non-pharmacological treatments, many patients will require medication to alleviate their pain.

MLMIC recognizes the complexity of treating patients suffering from chronic pain. Many patients require the use of a controlled substances. As a result, there are a number of concerns associated with treating these patients, and they may place a provider at risk for medical professional liability claims.

Common allegations seen in pain management claims can include:

1. Liability for failure to adequately treat pain.
2. Liability for allegedly inappropriately prescribing controlled substances.
3. Liability for failing to recognize a patient’s addiction.
4. Liability for failing to refer a patient to a pain management or mental health specialist.

MLMIC has developed several risk management tips to address the management of patients with chronic pain. Below are a few of our recommendations:

1. Perform and document a thorough initial evaluation of the patient. This should include a history and assessment of the impact of the pain on the patient, as well as the nature, type and causation of the pain. The provider should perform a focused physical examination to determine if there are any objective signs or symptoms of pain and review all pertinent diagnostic studies.
2. Develop a specific treatment plan based on the evaluation. Incorporate a written pain management agreement which outlines the expectations of the provider and responsibilities of the patient.
3. Maintain accurate and complete medical records that clearly support the rationale for the proposed treatment plan.
4. Perform a thorough informed consent discussion regarding the plan of care, including the risks, benefits and alternatives, as well as the risks of the alternatives, including no treatment with controlled substances.
5. Document and monitor all prescriptions and prescription refills.
6. Consult the New York State Prescription Monitoring Program (I-STOP) registry prior to prescribing any controlled pain medications and document that you have either consulted the registry or the circumstances why the consultation was not performed.

To review all our recommendations for managing patients with chronic pain, click here.

MLMIC insureds can contact our Risk Management Department at RMCconsultants@mlmic.com to obtain a copy of the checklist relating to this tip.

MLMIC policyholders can reach our 24/7 emergency support services for questions regarding managing patients with chronic pain by calling (844)-667-5291. You can also submit a specific question by sending an email request here.

If you are not already a MLMIC insured, learn more about us here.

Sources

1. https://www.nih.gov/news-events/news-releases/nih-study-finds-high-rates-persistent-chronic-pain-among-us-adults
2. https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm
3. https://www.nytimes.com/2023/05/17/well/live/chronic-pain-treatment.html
4. https://www.statnews.com/2024/04/12/study-high-physician-empathy-benefits-patients-lower-back-pain/
5. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2817441

This document is for general purposes only and should not be construed as medical or legal advice. This document is not comprehensive and does not cover all possible factual circumstances. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors for any questions related to legal, medical or professional obligations, the applicable state or federal laws or other professional questions.

The featured image for this blog post is from Pietro Jeng (Pexels).