The Oklahoma State Board of Medical Licensure and Supervision (Board) recognizes
that principles of quality medical practice dictate that the people of the State of
Oklahoma 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 policy, 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. The Board
encourages physicians 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 physicians should become
knowledgeable about assessing patients’ pain and effective methods of pain treatment, as
well as statutory requirements for prescribing controlled substances. Accordingly, this
policy has been developed to clarify the Board’s position on pain control, particularly as
related to the use of controlled substances, to alleviate physician uncertainty and to
encourage better pain management.
Inappropriate pain treatment may result from physicians’ 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 physician’s responsibility. As such, the Board 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 Board recognizes 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 Board will refer to current clinical
practice guidelines and expert review in approaching cases involving management of
pain. The medical 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 physician. 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. Physicians should recognize that
tolerance and physical dependence are normal consequences of sustained use of opioid
analgesics and are not the same as addiction.
The Board is obligated under the laws of the State of Oklahoma to protect the public
health and safety. The Board recognizes that the use of opioid analgesics for other than
legitimate medical purposes pose 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 Board expects that physicians incorporate safeguards into
their practices to minimize the potential for the abuse and diversion of controlled
Physicians should not fear disciplinary action from the Board for ordering, prescribing,
dispensing or administering controlled substances, including opioid analgesics, for a
legitimate medical purpose and in the course of professional practice. The Board 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 physician-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 Board will judge the validity of the physician’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
Allegations of inappropriate pain management will be evaluated on an individual basis.
The Board will not take disciplinary action against a physician for deviating from this
policy when contemporaneous medical records document reasonable cause for deviation.
The physician’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.