Current through Register Vol. 49, No. 2, February 2024
PAIN MANAGEMENT PROGRAMS
A. Physicians operating a pain management
program for specific syndromes...that is headache, low back pain, pain
associated with malignancies, or temporomandibular joint dysfunctions...are
expected to meet the standards set forth in this section or in fact be in
violation of the Medical Practice Act by exhibiting gross negligence or
ignorant malpractice.
B.
Definitions:
1. Chronic Pain Syndrome: Any
set of verbal and/or nonverbal behaviors that:
(1) involves the complaint of enduring
pain,
(2) differs significantly
from a person's premorbid status,
(3) has not responded to previous appropriate
medical and/or surgical treatment, and
(4) interferes with a person's physical,
psychological and social and/or vocational functioning.
2. Chronic Pain Management Program provides
coordinated, goal-oriented, interdisciplinary team services to reduce pain,
improving functioning, and decrease the dependence on the health care system of
persons with chronic pain syndrome.
3. "Chronic nonmalignant pain" means pain
requiring more than three (3) consecutive months of prescriptions for:
i. An opioid that is written for more than
the equivalent of ninety (90) tablets, each containing five milligrams (5mg) of
hydrocodone;
ii. A morphine
equivalent dose of more than fifteen milligrams (15mg) per day; or
iii. In the specific case of tramadol, a dose
of fifty milligrams (50mg) per one hundred twenty (120) tablets;
4. "Opioid" means a drug or
medication that relieves pain, including without limitation:
i. Hydrocodone;
ii. Oxycodone;
iii. Morphine;
iv. Codeine;
v. Heroin; and
vi. Fentanyl;
5. "Prescriber" means a practitioner or other
authorized person who prescribes a Schedule II, III, IV, or V controlled
substance.
C. The
following standards apply to both inpatient and outpatient programs and the
physician should conform to the same.
1. There
should be medical supervision of physician prescribed services.
2. A licensee should obtain a history and
conduct a physical examination prior to or immediately following admission of a
person to the Chronic Pain Management Program.
3. At the time of admission to the program,
the patient and the physician should enter into a written contract stating the
following:
a. The presenting problems of the
person served.
b. The goals and
expected benefits of admission.
c.
The initial estimated time frame for goal accomplishment.
d. Services needed.
D. In order to provide a safe pain
program, the scope and intensity of medical services should relate to the
medical care needs of the person served. The treating physician of the patient
should be available for medical services. Services for the patient in a Chronic
Pain Management Program can be provided by a coordinated interdisciplinary team
of professionals other than physicians. The members of the core team, though
each may not serve every person should include:
a. A Physician.
b. A clinical psychologist or
psychiatrist.
c. An occupational
therapist.
d. A physical
therapist.
e. A rehabilitation
nurse.
E. A physician
managing a Chronic Pain Management Program to a patient should meet the
following criteria:
1. Three years experience
in the interdisciplinary management of persons with chronic pain.
2. Participation in active education on pain
management at a local or national level.
3. Board certification in a medical specialty
or completion of training sufficient to qualify for examinations by members of
the American Board of Medical Specialties.
4. Two years experience in the medical
direction of an interdisciplinary Chronic Pain Program or at least six (6)
months of pain fellowship in an interdisciplinary Chronic Pain Program.
The physician must have completed and maintained at least one (1)
of the following:
5.
Attendance at one (1) meeting per year of a regional and national pain
society.
6. Presentation of an
abstract to a regional national pain society.
7. Publication on a pain topic in a peer
review journal.
8. Membership in a
pain society at a regional or national level.
F. Treatment of Chronic Nonmalignant Pain:
Patient evaluation - a patient who is being treated with
controlled substances for chronic nonmalignant pain shall be evaluated at least
one (1) time every six (6) months by a physician who is licensed by the
Arkansas State Medical Board, a. Prescriber requirements:
i. For a patient with chronic nonmalignant
pain, a prescriber, at a minimum and in addition to any additional requirements
of the Arkansas State Medical Board, shall:
1.
Check the prescriptive history of the patient on the Prescription Drug
Monitoring Program at least every six (6) months;
2. Have a signed pain contract with the
patient that states, at a minimum, the expectations of the prescriber for the
behavior of the patient which may include:
a.
A requirement for random urine drug screenings to help ensure that the patient
is abiding by the requirements of the contract; and
b. A requirement for random pill counts to
ensure compliance with the prescription.
ii. The requirements of this section shall
not apply to a patient:
1. Whose pain
medications are being prescribed for a malignant condition:
2. With a terminal condition;
3. Who is a resident of a licensed healthcare
facility;
4. Who is enrolled in a
hospice program; or
5. Who is in an
inpatient or outpatient palliative care program.
A prescriber who has been found by his or her licensing board to
be in violation of a rule or law involving prescription drugs shall be required
by the Arkansas State Medical Board to register with the Prescription Drug
Monitoring Program and access patient information before writing a prescription
for an opioid. The licensing board, in its discretion, may remove this
requirement after a period of time if the board deems removal of the
requirement appropriate.
