New Texas Medical Board rules for the treatment of pain

New rules for the treatment of acute or chronic pain went into effect Jan. 4, 2007. The new rules are an improvement over the old rules and provide a list of requirements for the treatment of pain. The Texas Medical Board’s intent is to encourage the proper treatment of pain.

According to the Texas Administrative Code, title 22, part 9, chapter 170, “Physicians should not fear Board action if they provide proper pain treatment. The board will not look solely at the quantity or duration of drug therapy. Proper pain management is not a matter of how much drug therapy is used as long as that therapy is based on sound clinical judgment. Sound clinical judgment results from evidence-based medicine and/or the use of generally accepted standards.”

Chapter 170 provides the following seven elements in the guidelines for the treatment of chronic pain.

1. A history and physical exam that specifically includes any history and potential for substance abuse;
2. A treatment plan that includes “objectives that will be used to determine treatment success, such as pain relief and improved physical and psycho-social function;”
3. Informed consent;
4. An agreement for treatment—the Texas Pain Society has developed a model document for Informed Consent and a Pain Management Agreement, which is posted on the Texas Pain Society Web site; www.texaspain.org, Updates, Ch 170;
5. Periodic review of the treatment of chronic pain;
6. Consultation and referral for “patients who are at risk for abuse or addiction;” and
7. Medical records, which “shall document the physician’s rationale for the treatment plan and the prescription of drugs for the chief complaint of chronic pain and show that the physician has followed these guidelines.”

For complete details go to the Texas Administrative Code, title 22, part 9, chapter 170.1-170.3. The new TMB rules are also posted on the Texas Pain Society Web site under TPS Updates.

The new TMB rules for the treatment of pain are the result of negotiations between the Texas Pain Society, the Texas Academy of Family Physicians and the Texas Medical Association over the past six years. The new rules are a balance between treating pain and safeguarding the public.

New laws were passed in this last legislative session concerning the hot political issue of pain treatment. Senate Bill 1879 establishes an interim study group called the Pain Treatment Review Committee. This committee shall study the relevant provisions in the laws of this state that relate to the administration of prescription medication, controlled substances and the needs of patients for effective pain control and management. This study group will report to the Legislature in one year.

SB 1879 also established what we have named the Texas All Schedules Prescription Electronic Reporting. TASPER is modeled after the National All Schedules Prescription Electronic Reporting, which was passed by the U.S. Congress in 2005. When fully implemented, TASPER will mandate electronic reporting by Texas pharmacists of controlled substances that have a potential for abuse and diversion so physicians, regulatory boards and law enforcement can track the prescribing of these medications.

Soon you should be able to find out if your patient is getting pain medication from other physicians. This is a very complicated law and we physicians will not know how it is going to impact medical practice until the rules implementing this new law are written. In fact, SB 1879 establishes an advisory committee of appointed physicians, pharmacists, and one member each from the TMB, Texas State Board of Pharmacy, State Board of Dental Examiners and the Board of Nurse Examiners to advise the Department of Public Safety on the implementation of this law. Hopefully when fully implemented, this will allow the “sunsetting” of the current official prescription program, triplicate prescriptions for schedule II drugs.