During the June TMB Board Meeting the board voted to amend Chapter 170 as follows:

CHAPTER 170. PAIN MANAGEMENT

§170.1, Purpose The Amendments to §170.1, concerning Purpose, clarify the requirements related to a physician’s treatment of pain. Throughout the section, amendments modify language so that the provisions are more clearly delineated as minimum requirements that a physician must do in every case when treating pain. Terms such as “policy” and “guideline(s)” have been changed to read as “rule(s)” and “minimum requirements”, and the term “should” has been changed in certain cases to “must.”

§170.2, Definitions The Amendments to §170.2, concerning Definitions, delete definitions for “improper pain treatment” and “nontherapeutic” found in paragraphs (8) and (9) respectively, as such terms are encompassed in the concept of the standard of care that will be determined and applied by the board in reviewing a physician’s treatment of pain. Other amendments reflect renumbering to account for the deleted provisions.

§170.3, Guidelines The Amendments to §170.3, concerning Guidelines, change the title of the section to “Minimum Requirements for the Treatment of Pain.” The amendments further clarify the requirements related to a physician’s treatment of pain. Throughout the section, amendments modify language so that the provisions are more clearly delineated as minimum requirements that a physician must do in every case when treating pain. Terms such as “policy” and “guideline(s)” have been changed to read as “rule(s)” and “minimum requirements”, and the term “should” has been changed to “must.”

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Please note that these changes, as they are, can have a significant impact on your practice and how your practice is perceived by the Board should your treatment of a patient or patients be reviewed. Every patient case is different. Healthcare professionals know that there is not a finite way of treating patients. In my experience, it has been the clinical approach that is taken in line with what the acceptable standards are at the time the treatment is rendered that defines what one may consider the standard of care or guideline. Therefore the change from the word “should” to a word like “must” may have a significant impact to your practice. Especially if you are under review by the Board and if your case is reviewed by someone without enough or any clinical experience to know that treatment of pain is ever changing with respect to new procedures, new studies on the use of medications and the application of certain procedures. If this is the case, a non-experienced person considering your practice and deciding whether or not to discipline you during investigative proceedings could take you to the very letter of the law without the realization that you are, in fact, squarely within the standard of care. Hopefully, such an occasion is rare and the Board will not allow this possibility. However, the feedback that I am hearing with respect to these changes reflect the concern of the aforementioned scenario happening. However, do not get lost in the nightmare possibility of such a scenario and lose heart. Have faith in the greater practice of medicine and practice it well. Do not be afraid of innovation and progress. Have faith in your practice and always educate yourself with current Board rules and the cutting edge of your specialty. Also understand that these rule changes will be enforced and the Board will also take each case on a case by case basis as they review and apply the rule and any changes. It is our hope that good medicine and the practice there of will bring about change and better practices and stronger rules and regulations and that in turn, stronger rules and regulations will bring about good medicine and better practices. Therefore, be mindful of the rule changes and apply it. You will hopefully find that it enhances what you are already doing and that you are already abiding by it because of your longstanding good practice of pain.

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