Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 380 - STATE BOARD OF NURSING › Chapter 21 - USE OF CONTROLLED SUBSTANCES FOR TREATMENT OF PAIN › Section 380-21-1 - Joint Statement on the Treatment of Pain

Current through 2024-29, July 17, 2024
The Boards recognize that principles of quality medical,
				  dental and advanced nursing practice dictate that the people of the State of
				  Maine have access to appropriate and effective pain relief. The appropriate
				  application of up-to-date knowledge and treatment modalities can serve to
				  improve the quality of life for those patients who suffer from pain as well as
				  to reduce the morbidity and costs associated with untreated or inappropriately
				  treated pain. For the purposes of this rule, the inappropriate treatment of
				  pain includes nontreatment, undertreatment, overtreatment and the continued use
				  of ineffective treatments.
The diagnosis and treatment of pain is integral to the
				  practice of medicine, dentistry and advanced nursing. The Boards encourage
				  clinicians to view pain management as a part of quality medical practice for
				  all patients with pain, acute or chronic, and it is especially urgent for
				  patients who experience pain as a result of terminal illness. All clinicians
				  should become knowledgeable about assessing patients' pain and effective
				  methods of pain treatment, as well as statutory requirements for prescribing
				  controlled substances. Accordingly, this rule has been developed to clarify the
				  Boards' position on pain control, particularly as related to the use of
				  controlled substances, to alleviate clinician uncertainty and to encourage
				  better pain management.
Inappropriate pain treatment may result from clinicians' lack
				  of knowledge about pain management. Fears of investigation or sanction by
				  federal, state and local agencies may also result in inappropriate treatment of
				  pain. Appropriate pain management is the treating clinician's responsibility.
				  As such, the Boards will consider the inappropriate treatment of pain to be a
				  departure from standards of practice and will investigate such allegations,
				  recognizing that some types of pain cannot be completely relieved, and taking
				  into account whether the treatment is appropriate for the diagnosis.
The Boards recognize controlled substances, including opioid
				  analgesics, may be essential in the treatment of acute pain due to trauma or
				  surgery and chronic pain, whether due to cancer or non-cancer origins. The
				  Boards will refer to current clinical practice guidelines and expert review in
				  approaching cases involving management of pain. The management of pain should
				  consider current clinical knowledge and scientific research and the use of
				  pharmacologic and non-pharmacologic modalities according to the judgment of the
				  clinician. Pain should be assessed and treated promptly and the quantity and
				  frequency of doses should be adjusted according to the intensity, duration of
				  the pain and treatment outcomes. Clinicians should recognize that tolerance and
				  physical dependence are normal consequences of sustained use of opioid
				  analgesics and are not the same as addiction.
The Boards are obligated under the laws of the State of Maine
				  to protect the public health and safety. The Boards recognize that the use of
				  opioid analgesics for other than legitimate medical purposes poses a threat to
				  the individual and society and that the inappropriate prescribing of controlled
				  substances, including opioid analgesics, may lead to drug diversion and abuse
				  by individuals who seek them for other than legitimate medical use.
				  Accordingly, the Boards expect that clinicians will incorporate safeguards into
				  their practices to minimize the potential for the abuse and diversion of
				  controlled substances.
Clinicians should not fear disciplinary action from the
				  Boards for ordering, prescribing, dispensing or administering controlled
				  substances, including opioid analgesics, for a legitimate medical purpose and
				  in the course of professional practice. The Boards will consider prescribing,
				  ordering, dispensing or administering controlled substances for pain to be for
				  a legitimate medical purpose if based on sound clinical judgment. All such
				  prescribing must be based on clear documentation of unrelieved pain. To be
				  within the usual course of professional practice, a clinician-patient
				  relationship must exist and the prescribing should be based on a diagnosis and
				  documentation of unrelieved pain. Compliance with applicable state and/or
				  federal law is required.
The Boards will judge the validity of the clinician's
				  treatment of the patient based on available documentation, rather than solely
				  on the quantity and duration of medication administration. The goal is to
				  control the patient's pain while effectively addressing other aspects of the
				  patient's functioning, including physical, psychological, social and
				  work-related factors.
Allegations of inappropriate pain management will be
				  evaluated on an individual basis. The Boards will not take disciplinary action
				  against a clinician for deviating from this rule when contemporaneous medical
				  records document reasonable cause for deviation. The clinician's conduct will
				  be evaluated to a great extent by the outcome of pain treatment, recognizing
				  that some types of pain cannot be completely relieved, and by taking into
				  account whether the drug used is appropriate for the diagnosis, as well as
				  improvement in patient functioning and/or quality of life.