Medical College of Wisconsin
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Implementation of a formal treatment agreement for outpatient management of chronic nonmalignant pain with opioid analgesics. J Pain Symptom Manage 1995 Oct;10(7):556-63



Pubmed ID





We describe the creation and implementation of a formal treatment agreement between patients suffering from chronic nonmalignant pain and the pain management team at our institution. Key features of the agreement include acknowledgement that previous treatment strategies have been inadequate, use of extensive written explanations of the side effects and risks of opioid therapy (including the potential for addiction), outlining of the conditions under which therapy will be conducted, creation of a broad support structure of fully informed health professionals to monitor closely and protect the patient, and emphasis on the importance of pain relief coupled to enhanced function via the active continuation of other therapy. All patients carry a Medical Alert card identifying them as participants in the program. During the past 3 years, a total of 67 patients with refractory nonmalignant pain have been successfully treated with oral opioids using the agreement as a basis for therapy. The treatment agreement provides the necessary structure to formalize this therapeutic approach and emphasizes the mutual responsibilities of the patient and the pain management team.

Author List

Burchman SL, Pagel PS


Paul S. Pagel MD, PhD Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Ambulatory Care
Analgesics, Opioid
Chronic Disease
jenkins-FCD Prod-387 b0ced2662056320369de4e5cd5f21c218c03feb3