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Effective management of pain


Ohio Pain Initiative
2233 North Bank Drive
Columbus, Ohio 43220
P: (614) 763-PAIN (7246)
F: (614) 763-0050
E: ohiopain@ohiopaininitiative.org

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"Intractable Pain Treatment Act"

(Sections 4731.052 and 4731.283, Ohio Revised Code)
Substitute HB 187
Effective 10/14/97

Components of the bill:

  • Provides a definition of "intractable pain";
  • equires that the State Medical Board adopt rules establishing standards to be followed by physicians in the diagnosis and treatment of intractable pain;
  • Allows a physician to treat intractable pain with appropriate amounts or combinations of drugs;
  • Mandates consultation prior to making a diagnosis of intractable pain
  • Outlines required medical documentation;
  • Provides that a physician treating intractable pain in accordance with this law and subsequent rules is not subject to disciplinary action;
  • Requires that the State Medical Board approve continuing medical education courses regarding the diagnosis and treatment of intractable pain offered by various professional associations.

The following are highlights of the rules adopted by the State Medical Board of Ohio related to the treatment of intractable pain:

  • Distinguish between physical dependence or analgesic tolerance and addiction;
  • Outline standards for diagnosing and managing intractable pain;
  • Address fear of regulatory scrutiny

The complete text of the rules, which can be found at:

Below are some selected provisions from HB 187:

ORC 4732.052 (A)(2) Definition of intractable pain:
Intractable pain means a state of pain that is determined, after reasonable medical efforts have been made to relieve the pain or cure its cause, to have a cause for which no treatment or cure is possible or for which none has been found.

ORC 4732.052 (B) State Medical Board rule-making authority:
The state medical board shall adopt rules ... that establish standards and procedures to be followed by physicians in the diagnosis and treatment of intractable pain, including standards for managing intractable pain by prescribing, personally furnishing, or administering dangerous drugs in amounts or combinations that may not be appropriate when treating other medical conditions. ...

ORC 4723.052 (C) Standards for Treatment and Documentation:
When a physician diagnoses an individual as having intractable pain, the physician may treat the pain by managing it with dangerous drugs in amounts or combinations that may not be appropriate when treating other medical conditions. The physician's diagnosis shall be made after having the individual evaluated by one or more other physicians who specialize in the treatment of the area, system, or organ of the body perceived as the source of the pain. The physician's diagnosis and treatment decisions shall be made according to accepted and prevailing standards for medical care. The physician shall maintain a record of all of the following:

  1. Medical history and physical examination of the individual;
  2. The diagnosis of intractable pain, including signs, symptoms, and causes;
  3. The plan of treatment proposed, the patient's response to treatment, and any modification to the plan of treatment;
  4. The dates on which dangerous drugs were prescribed, furnished, or administered, the name and address of the individual to or for whom the dangerous drugs were prescribed, dispensed, or administered, and the amounts and dosage forms for the dangerous drugs prescribed, furnished, or administered;
  5. A copy of the report made by the physician or the physician to whom referral for evaluation was made under this division.

ORC 4731.052 (D) Addresses fear of regulatory scrutiny:
A physician who treats intractable pain by managing it with dangerous drugs is not subject to disciplinary action by the board under section 4731.22 of the Revised Code solely because the physician treated the intractable pain with dangerous drugs. The physician is subject to disciplinary action only if the dangerous drugs are not prescribed, furnished, or administered in accordance with this section and the rules adopted under it.

ORC 4731.283 Continuing education courses regarding intractable pain
Not later than ninety days after the effective date of this section, the state medical board shall approve one or more continuing medical education courses of study ... certified by the Ohio State Medical Association and the Ohio Osteopathic Association ... that assist doctors ... in diagnosing and treating intractable pain, ...