The treatment of pain is a vital part of the practice of medicine.
Patients look to physicians not only to cure disease, but also to
try to relieve their pain. Physicians should be able to treat their
patients' pain using sound clinical judgment without fear that the
board will pursue disciplinary action. Sound clinical judgment results
from the use of generally accepted standards of care, which include
evidence-based medicine, when available. This rule sets forth minimum
requirements related to the proper treatment of pain. The board's
intent is to protect the public and give guidance to physicians. The
principles underlying this rule include:
(1) Pain is a medical condition that every physician
sees regularly. It is an integral part of the practice of medicine.
Patients deserve to have medical treatment for their pain, whether
the pain is acute or chronic, mild or severe. The goal of pain management
is to treat the patient's pain in relation to overall health, including
physical function, psychological, social, and work-related factors.
(2) The regulatory atmosphere must support a physician's
ability to treat pain, no matter how difficult the case, using whatever
tools are most appropriate. Drugs, including opiates, are essential
tools for the treatment of pain.
(3) The board is charged by the Legislature with the
responsibility to assure that drugs are used in a therapeutic manner.
A license to practice medicine gives a physician legal authority to
prescribe drugs for pain. The physician has a duty to use that authority
to help, and not to harm patients and the public.
(4) Harm can result when a physician does not use sound
clinical judgment in using drug therapy. If the physician fails to
apply sufficient drug therapy, the patient will likely suffer continued
pain and may demonstrate relief-seeking behavior, known as pseudoaddiction.
On the other hand, non-therapeutic drug therapy may lead to or contribute
to abuse, addiction, and/or diversion of drugs. As with everything
in the practice of medicine, physicians must be well informed of and
carefully assess the risks and the benefits as they apply to each
(5) The extent of medical records must be legible,
complete, accurate and current for each patient.
(6) Treatment of chronic pain requires a reasonably
detailed and documented plan to assure that the treatment is monitored
and evaluated on an ongoing basis.
(7) The intent of the board is not to impose regulatory
burdens on the practice of medicine. Rather, these rules set forth
those items expected to be done by any reasonable physician involved
in the treatment of pain.
|Source Note: The provisions of this §170.1 adopted to be effective January 4, 2007, 31 TexReg 10798; amended to be effective January 20, 2014, 39 TexReg 279; amended to be effective August 4, 2015, 40 TexReg 4898