FEDERATION OF STATE MEDICAL
BOARDS PRESCRIBING GUIDELINES
FOR NARCOTICS FOR CHRONIC PAIN

1. Evaluation of the Patient:  A complete medical history and physical examination must be
conducted and documented in the medical record. The medical record should document the
nature and intensity of the pain, current and past treatments for pain, underlying or coexisting
diseases or conditions, the effect of the pain on physical and psychological function, and
history of substance abuse. The medical record also should document the presence of one or
more recognized medical indications for the use of a controlled substance.
2. Treatment Plan: The written treatment plan should state objectives that will be used to
determine treatment success, such as pain relief and improved physical and psychosocial
function, and should indicate if any further diagnostic evaluations or other treatments are
planned. After treatment begins, the physician should adjust drug therapy to the individual
medical needs of eachpatient. Other treatment modalities or a rehabilitation program may be
necessary depending on the etiology of the pain and the extent to which the pain is
associated with physical and psychosocial impairment.
3. Informed Consent and Agreement for Treatment     The physician should discuss the risks
and benefits of the use of controlled substances with the patient, persons designated by the
patient or with the patient’s surrogate or guardian if the patient is incompetent. The patient
should receive prescriptions from one physician and one pharmacy where possible. If the
patient is determined to be at high risk for medication abuse or have a history of substance
abuse, the physician may employ the use of a written agreement between physician and
patient outlining patient responsibilities, including  urine/serum medication levels screening
when requested; number and frequency of all prescription refills; and reasons for which drug
therapy may be discontinued (i.e., violation of agreement).
4. Periodic Review: At reasonable intervals based on the individual circumstances of the
patient, the physician should review the course of treatment and any new information about
the etiology of the pain. Continuation or modification of therapy should depend on the
physician’s evaluation of progress toward stated treatment objectives, such as improvement
in patient’s pain intensity and improved physical and/or psychosocial function, i.e., ability to
work, need of health care resources, activities of daily living and quality of social life. If
treatment goals are not being achieved, despite medication adjustments, the physician should
reevaluate the appropriateness of continued treatment. The physician should monitor patient
compliance in medication usage and related treatment plans.
5. Consultation:  The physician should be willing to refer the patient as necessary for
additional evaluation and treatment in order to achieve treatment objectives. Special attention
should be given to those pain patients who are at risk for misusing their medications and
those whose living arrangement pose a risk for medication misuse or diversion. The
management of pain in patients with a history of substance abuse or with a comorbid
psychiatric disorder may require extra care, monitoring, documentation and consultation with
or referral to an expert in the management of such patients.
6. Medical Records:  The physician should keep accurate and complete records to include the
medical history and physical examination;  diagnostic, therapeutic and laboratory results;         
evaluations and consultations; treatment objectives;  discussion of risks and benefits;
treatments; medications (including date, type, dosage and quantity prescribed); instructions
and agreements; and periodic reviews.
Records should remain current and be maintained in an accessible manner and readily
available for review.
7. Compliance With Controlled Substances Laws and Regulations: To prescribe, dispense or
administer controlled substances, the physician must be licensed in the state and comply with
applicable federal and state regulations. Physicians are referred to the Physicians Manual of
the U.S. Drug    Enforcement Administration and (any relevant documents issued by the state
medical board) for specific rules governing controlled substances as well as applicable state
regulations