(NEW YORK) -- An increasing number of patients are being required to sign pain agreements, and doctors who use them say the documents are an effective way to communicate what the expectations are for the treatment of chronic pain using opioids, and how patients can use these medications safely.
But critics of the agreements, sometimes called contracts, say they undermine the patient-provider relationship.
Pain agreements vary from provider to provider, but in general, they outline conditions patients must meet to continue treatment for chronic pain.
"For example, the agreement may say patients have to keep the medication out of of other people's reach, the medication has to be kept in a locked container, there are no early refills, no sharing of medication, they may be required to submit to random tests to determine whether there's compliance and so forth," said Dr. Melvin Gitlin, chairman of the Department of Anesthesiology, Perioperative and Pain Management Medicine at the University of Miami's Miller School of Medicine.
In addition to random testing, doctors may require patients to have their pills counted to make sure they're the only ones taking them, or require them to use only one pharmacy.
The American Academy of Pain Medicine, the American Pain Society and the Federation of State Medical Boards all recommend the use of opioid agreements in certain circumstances. They started recommending the use of agreements in the late 1990s, according to Gitlin.
But the Center for Practical Bioethics, a Kansas City, Missouri, nonprofit policy institute, believes these agreements can create an adversarial relationships between patients and providers.
Last November, a panel of pain and policy experts, including some from the Center for Practical Bioethics, published an in-depth discussion of pain contracts.
One criticism was that the contracts put chronic sufferers, often in a weakened and vulnerable state, at the mercy of providers, shifting the balance in the patient-provider relationship. Another concern is that the language could offend patients.
Copyright 2011 ABC News Radio