Pain Rules, Part 5
Treatment Plans
For the Board, it is critical that each chronic pain patient receive an individualized treatment plan. This plan must be in the medical record. The treatment plan should include the following:
- 1. how the medication relates to the chief presenting complaint of chronic pain[1];
- 2. dosage and frequency of any drugs prescribed[2];
- 3. further testing and diagnostic evaluations to be ordered[3];
- 4. other treatments that are planned or considered[4];
- 5. periodic reviews planned[5]; and,
- 6. objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function.[6]
Treatment plans can be a critical tool in demonstrating medical rationale for treatment. Treatment plans under this rule, and as well as under the Board’s rules for other medical records[7], are essentially a written plan of action that is given to the patient with both subjective and objective measures that the doctor and the patient agree upon in order to achieve their stated medical goal. The treatment plan should be provided to the patient and be in the medical record. This document establishes a course of action for the patient and the medical treatment to take on the condition the patient presents with.
A critical consideration with treatment plans is they are not a static document and are constantly being revised based on the condition, the progress of the patient, achieving goals, and the like. The treatment plan is an evolving document that provides structure for the patient and evidence of success of the treatment or a need to re-evaluate the course of action. Treatment plans must be developed with input from the patient and other health care professionals that are treating the patient. This is a multi-disciplinary approach to care. It is necessary that everyone involved in the treatment plan buys-in from the start, otherwise there will be conflict. The parties need to work together to determine if the goals and treatment objectives are being met.
[1] 22 Texas Administrative Code §170.3(a)(2)(A). (2007)
[2] 22 Texas Administrative Code §170.3(a)(2)(B). (2007)
[3] 22 Texas Administrative Code §170.3(a)(2)(C). (2007)
[4] 22 Texas Administrative Code §170.3(a)(2)(D). (2007)
[5] 22 Texas Administrative Code §170.3(a)(2)(E). (2007)
[6] 22 Texas Administrative Code §170.3(a)(2)(F). (2007)
[7] 22 Texas Administrative Code §165.1. Also see “Dissolute Documentation: TMB Rewrites the Rules for Medical Records” The Record TMLT March/April 2007. Jon Porter and Jane Holeman.
