Medicolegal aspects of pain management

The clinician who prescribes narcotic analgesics for the treatment of chronic pain must be familiar with, and observe, the statutory requirements that control the medical use of controlled substances. All treatment must be discussed with and explained to the patient beforehand, and the various alternatives clearly described. Patients should be warned of any real risks and possible adverse effects. However, the law, as it stands at present in Australia, Canada and the UK, does not require the doctor to present in all instances every possible adverse effect, whereas, in the USA, under the doctrine of 'informed consent' all such information must be given to the patient. Nevertheless, in Australia, Canada and the UK, if the patient specifically asks about a possible complication of treatment, which the treating doctor had not mentioned, then this has to be fully discussed. All the information presented to the patient and the discussion concerning treatment options and risks of the treatment undertaken should be fully documented. A significant proportion of patients with chronic noncancer pain are involved in personal injury litigation, and the treating doctor should be familiar with those aspects of chronic pain that are of relevance to the legal process. The potential hazards of pain treatment must be borne in mind, and the patient's right to effective and timely relief of pain must be the treating physician's paramount consideration.