TMB issues final rules for pain management

August 4, 2020

Laura Hale Brockway

August 4, 2020

In July, the Texas Medical Board adopted final rules clarifying what physicians must do to comply with pain management legislation passed in 2019. Below are summaries of the new TMB rules, which can be reviewed in Chapter 170 — Prescription of Controlled Substances.

Requirement to check the PMP

Since 2019, state law has required physicians to check the Texas Prescription Monitoring Program (PMP) before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. The TMB has clarified their rules as follows.

The review of the patient's PMP prescribing history must be completed prior to and each time a prescription is issued for opioids, benzodiazepines, barbiturates, and carisoprodol.
“The review of the patient's PMP prescribing history must be completed prior to and each time a prescription is issued for opioids, benzodiazepines, barbiturates, or carisoprodol to the patient for:

(A) take-home use, upon leaving an outpatient setting such as doctor's office, or ambulatory surgical center; or

(B) upon discharge from an inpatient setting, such as a hospital admission or discharge from an emergency department visit.

(2) A mandatory PMP check is not required before or during an inpatient stay, such as a hospital admission, or during an outpatient encounter in settings, such as an emergency department or ambulatory surgical center visit.” (Chapter 170.9)

PMP checks must be documented in the patient’s medical record.

Exceptions to the mandated PMP check include prescriptions for hospice care, cancer care, and treatment for sickle-cell disease. Another exception occurs if a prescriber tries to access the PMP, but cannot because of circumstances out of the prescriber’s control. Any exception needs to be documented in the patient’s record.

Limits on prescribing for acute pain

In 2019, Texas law was passed that limits acute-pain prescriptions for opioids to 10 days. In response, the TMB has amended its definitions of acute and chronic pain and created new definitions.

The definitions now include a time element from the date of the initial opioid prescription:

Acute pain: Pain that is time-limited to no more than 30 days from the date of the initial prescription for opioids during a period of treatment related to the acute condition or injury.;
Chronic pain: Pain that “is not relieved with acute, post-surgical, post-procedure, or persistent non-chronic pain treatment parameter” and exists for more than 91 days from the date of the initial prescription; and
Post-surgical, post-procedure, persistent non-chronic pain: Pain “that occurs due to trauma caused by the surgery or procedure; or an underlying condition, disease, or injury causing persistent non-chronic pain” and lasting 31-90 days from the date of the initial prescription for opioids.

Under these definitions, the 10-day limit will apply to opioid prescriptions for acute pain. Further guidance on prescribing limits for acute pain can be found here and in the Texas Health and Safety Code Sec. 481.07636.