Pain management and the use of controlled substances: is a "standard of practice" standard practice?

Fishbain and his colleagues should be commended for providing us an analysis detailing how a case report about a patient's pain treatment was legally evaluated against a prevailing standard of care—here represented by the Federation of State Medical Board's (the Federation) Model Guidelines for the Use of Controlled Substance for the Treatment of Pain ( Model Guidelines ) [1]. The Federation, in collaboration with a multidisciplinary team of experts, created the Model Guidelines in 1998 to encourage the state agencies that license and discipline physicians to adopt policy 1) promoting safe and effective pain relief, including the use of opioid analgesics; 2) ensuring that physicians will not be sanctioned solely for prescribing such medications for legitimate medical purposes; and 3) stressing the need to safeguard against medication diversion and abuse [2]. As drafted, the Model Guidelines contain a set of recommendations to guide clinical decision-making, based on the needs of the particular patient situation; although the authors state that the Model Guidelines contain “six general sections” (p. 10) [3], actually, there are seven specific guidelines including, importantly, the need for practitioners to comply with federal- and state-controlled substances statutes and regulations. In 2004, the Federation updated the Model Guidelines , resulting in a …