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. This Rule sets forth the board's policy for the proper treatment of pain. The board's intent is to protect the public and give guidance to physicians. The principles underlying this policy include:

1. (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. (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. (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. (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 case.
5. (5) 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 treatment 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.
6. (6) A physician can demonstrate sound clinical judgment by recording the physician's rationale for the treatment plan and maintaining medical records that are legible, complete, accurate and current for each patient.
7. (7) The extent of medical records should be reasonable for each case. A treatment plan for acute, episodic pain may note only the dosage and frequency of drugs prescribed and that no further treatment is planned.
8. (8) Treatment of chronic pain requires a reasonably detailed and documented plan to assure that the treatment is monitored. An explanation of the physician's rationale is especially required for cases in which treatment with scheduled drugs is difficult to relate to the patient's objective physical, radiographic, or laboratory findings.
9. (9) The intent of these guidelines is not to impose regulatory burdens on the practice of medicine. Rather, these guidelines are intended to set forth those items expected to be done by any reasonable physician involved in the treatment of pain. The use of the word "shall" in these guidelines is used to identify those items a physician is required to perform in all such cases. The word "should" and the phrase "it is the responsibility of the physician" in these guidelines are used to identify those actions that a prudent physician will either do and document in the treatment of pain or be able to provide a thoughtful explanation as to why the physician did not do so.

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.