Pain Rules - Part Four
Initial Encounter
Upon the initial visit with the patient, the doctor must spend some quality time with the patient. There is a necessity to gather a substantial amount of information in order to come to the conclusion that the individual suffers from chronic pain. The doctor must obtain a “…medical history and physical examination that includes a problem-focused exam specific to the chief presenting complaint of the patient.”[1] The medical record must obviously document the history and physical. The medical records should include at a minimum:
- 1. the nature and intensity of the pain[2];
- 2. current and past treatments for pain[3];
- 3. underlying or coexisting diseases and conditions[4];
- 4. the effect of the pain on physical and psychological function[5];
- 5. any history and potential for substance abuse;[6] and,
- 6. the presence of one or more recognized medical indications for the use of a dangerous or scheduled drug.[7]
Again, the expectation of the Board is there will be a strong narrative supporting the information gathered. The nature of the pain should be descriptive (i.e. burning, stabbing, throbbing) and should be tied to actions (i.e. sitting, standing, working, sleeping). The intensity should be some type of scale that represents or even visually demonstrates the level of pain. The most common examples are the one to ten scale, with ten being the worst possible pain, or the smiley to frowny faces visually representing the level of pain. The family or self-history of substance abuse is also a critical factor. If there is positive history, this must be explored in great detail. The general belief of the Board is such an individual requires psychiatric evaluation to determine the likelihood for addiction and to opine as to whether treatment with narcotics is ultimately in the patient’s best interests. If for some reason the doctor decides to treat the patient with such a history and against the recommendation of the evaluator, the physician must greatly explain their medical rationale for doing so.
Please submit questions or concerns to Jon Porter
Part 5 soon
[1] 22 Texas Administrative Code §170.3(a)(1)(A). (2007)
[2] 22 Texas Administrative Code §170.3(a)(1)(B)(i). (2007)
[3] 22 Texas Administrative Code §170.3(a)(1)(B)(ii). (2007)
[4] 22 Texas Administrative Code §170.3(a)(1)(B)(iii). (2007)
[5] 22 Texas Administrative Code §170.3(a)(1)(B)(vi). (2007)
[6] 22 Texas Administrative Code §170.3(a)(1)(B)(v). (2007)
[7] 22 Texas Administrative Code §170.3(a)(1)(B)(vi). (2007)
