Open Access Open Access  Restricted Access Subscription or Fee Access

A snap shot of patients’ recall, attitudes, and perceptions of their pain contracts from a family medicine resident outpatient clinic

Robinder Bahniwal, MD, Jarrett Sell, MD, Abdul Waheed, MD, FAAFP


Objective: Determine patient recall, attitudes, and perceptions of their pain contract in a family medicine resident outpatient clinic.

Design: A cross-sectional study design using a telephone survey to all eligible subjects who signed a hardcopy pain contract from August 29, 2014 to May 19, 2016 at a resident outpatient clinic.

Setting: Penn State Hershey Family and Community Medicine Residency clinic.

Participants: All patients who signed a hardcopy pain contract at the practice site who met specific inclusion criteria.

Main outcome measures: What proportions of items are remembered from the standardized Penn State Hershey pain contract and does recall vary with time of contract signing.

Secondary outcome measures: Patient attitudes and perceptions of their pain contract.

Results: Ninety-five percent of patients recalled agreeing to random urine drug screens (UDS) and 60 percent recalled they were not to receive prescriptions from another provider unless approved by their practice site. The recall rate for the remaining 33 items in the contract ranged from 0 percent to 20 percent. The highest recall rate was for contracts signed between 0-3 months. Patient feedback regarding the pain contract was recorded and while five were positive or neutral, 15 patients recorded negative attitudes toward the process, the physician, and/or the UDS.

Conclusions: This study highlights limited recall and negative patient attitudes toward the pain contract. Considering the public health concerns with regard to the current opioid epidemic in the United States, additional training of providers, redesign of pain contracts and new models for informing patients about safe chronic pain management may be warranted.


opioids, pain contract, outpatient, primary care, agreement, patient understanding, attitudes, perceptions

Full Text:



Arnold R, Han P, Seltzer D: Opioid contracts in chronic nonmalignant pain management: Objectives and uncertainties. Am J Med. 2006; 119: 292-296.

Fishman S, Bandman T, Edwards A, et al.: The opioid contract in the management of chronic pain. J Pain Symptom Manage. 1999; 18(1): 27-37.

Albrecht S, Khokhar B, Pradel F, et al.: Perceptions of patient provider agreements. J Pharm Health Serv Res. 2015; 6(3): 139-144.

Starrels J, Becker W, Alford B, et al.: Systematic review: Treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. 2010; 152: 712-720.

Hariharan J, Lamb G, Neuner J: Long term opioid contract use for chronic pain management in primary care practice. A five year experience. J Gen Intern Med. 2007; 22(4): 485-490.

Collen M. Opioid contracts and random drug testing for people with chronic pain. Think twice. J Law Med Ethics. 2009; 37(4): 841-845.

Osterberg L, Blaschke T: Adherence to medication. N Engl J Med. 2005; 353: 487-497.

Katz NP, Sherburne S, Beach M, et al.: Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesth Analg. 2003; 97(4): 1097-102.

Wiedemer L, Harden P, Arndt I, et al.: The opioids renewal clinic: A primary care, managed approach to opioid therapy in chronic pain patients at risk for substance abuse. Pain Med. 2007; 8(7): 573-584.

Khalid L, Liebschutz J, Xuan Z, et al.: Adherence to prescription opioid monitoring guidelines among residents and attending physicians in the primary care setting. Pain Med. 2015; 16(3): 480-487.



  • There are currently no refbacks.