The valid informed consent-treatment contract in chronic non-cancer pain: Its role in reducing barriers to effective pain management

Abstract

The Valid Informed Consent-Treatment Contract is an effective and ethical guide for a physician's care of the patient with chronic non-cancer pain.

Do Internal Medicine Residents Find Pain Medication Agreements Useful?

“…7 At the same time, reports of increased poisoning deaths from nonillicit opioids 8 and concerns about prescription medication misuse, [9][10][11] have led to a number of recommendations about steps physicians should take to minimize the potential for misuse of opioids prescribed for CNCP. [12][13][14] One of the most consistent recommendations is that physicians consider using a pain medication agreement (PMA), signed by the patient and physician, which describes the conditions under which chronic opioid therapy will occur. [12][13][14] The American Academy of Pain Medicine has produced a ''Sample Agreement for Longterm Controlled Substances Therapy for Chronic Pain,'' 15 and PMAs have been widely adopted by pain treatment centers.…”

Literacy Demands and Formatting Characteristics of Opioid Contracts in Chronic Nonmalignant Pain Management

“…1,3,7,9 However, there is some controversy about the value of OCs in certain patient populations, the nature of the information included, and their ability to accomplish positive outcomes. Nonetheless, guidelines have been offered regarding the content and tone of the OC.…”

“…Nonetheless, guidelines have been offered regarding the content and tone of the OC. 7,9 For an OC to be effective in outlining the conditions of treatment, it must be presented in a format that facilitates patient understanding and ultimately the informed consent process. Unfortunately, much of the patient education literature 2,8,10,11,[28][29][30] and informed consent documents 15,18 are written at a reading level requiring advanced literacy skills.…”

Development and Validation of a Low-Literacy Opioid Contract

“…10 Given the potential adverse outcomes related to opioid abuse and misuse on both individual and societal levels, an Opioid Contract (OPC) could potentially serve as a vehicle in outlining the criteria and circumstances for which opioids are prescribed. 9,14 In a recent study of English-language OPCs used by American Pain Society members, Roskos et al 25 found that all OPCs required advanced health literacy skills to fully comprehend. However, as highlighted in national reports by the Institute of Medicine, 21 American Medical Association Foundation, 26 and National Assessment of Adult Literacy 20 only a small proportion of American adults have proficient health literacy skills.…”