New Mexico Boards of Medical Practice, Nursing, and Pharmacy
Approved: May 5, 2005

Joint Statement on the Management of Chronic Pain

Pain management is a significant issue in health care today. Estimates of Americans experiencing pain range from 50-75 million persons annually. Thirty to fifty percent of patients undergoing cancer treatment experience pain. The effects of unmanaged pain are serious and wide-ranging and, yet, pain is widely under-treated. Untreated or inadequately treated pain impacts patients’ quality of life and increases health care costs. Factors cited in the under-treatment of pain include concerns about causing addiction or tolerance; inadequate knowledge of controlled substances and pain management; fear of scrutiny and discipline by regulatory agencies; inadequate assessment; and patient reluctance to report pain or to take pain medications.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) guidelines on pain management state, “Patients have the right to appropriate assessment and management of pain.” (Emphasis added). It is, therefore, incumbent upon New Mexico physicians, nurses and pharmacists to work cooperatively and effectively to address the dimensions of pain and to provide maximum pain relief with minimal side effects. Towards that end, and in the interest of public protection, the New Mexico Boards of Medical Practice, Nursing and Pharmacy issue the following joint statement.

To effectively assist patients in the management of chronic pain, health care professionals should, within their scope of practice:

• Consistently and thoroughly assess all patients for pain. If the patient reports untreated or inadequately treated chronic pain, the pain should be evaluated with a complete history and physical with laboratory and diagnostic testing, if indicated;
• Work collaboratively in a multi-disciplinary approach to develop and implement an individualized, written treatment plan utilizing pharmacologic and non-pharmacologic interventions with specific objectives for the patient;
• Regularly evaluate the effectiveness of the treatment plan, using a consistent, developmentally appropriate, standardized pain scale, and make adjustments as needed;
• Document all aspects of pain assessment and care in a timely, clear, consistent, complete and accurate manner;
• Anticipate and effectively manage side effects of pain medications;
• Provide adequate and culturally appropriate information to patients and family members or caregivers to support patients in making informed decisions and participate in the management of their pain;
• Be aware of the risks of diversion and abuse of controlled substances and take appropriate steps to minimize there risks;
• Recognize individuals with chemical dependency may experience pain requiring medications, including opioids, and may require specialized management;
• Consult with, and refer patients to, other providers when appropriate;
• Develop organization-appropriate and evidence-based policies and protocols for pain management;
• Become and remain knowledgeable regarding effective pain management; and
• Comply with all state and federal laws and regulations regarding prescribing, dispensing, and administering legend drugs, including controlled substances.