Recently, the Federation of State Medical Boards (FSMB) of the United States has encouraged state medical boards to update the Model Guidelines for the Use of Controlled Substances for the Treatment of Pain. The revised guidelines were submitted to the FSMB's House of Delegates in May for consideration as policy. The FSMB hopes undertreatment of pain will be as much of a violation of the standard of care as other kinds of prescribing violations.

In an interview by Medscape reporter Laurie Barclay asked James N. Thompson, MD, president and chief executive officer of the FSMB, "What was the rationale for the FSMB recommending a revision of guidelines regarding pain treatment?" Dr. Thompson replied, "The guidelines address the inadequate management of pain and barriers that stand in the way of patients getting appropriate treatment. These barriers include a lack of knowledge among some physicians on what appropriate pain management entails. Another obstacle is a fear some physicians have that they'll be investigated by regulators if they prescribe controlled substances for pain."

According to Dr. Thompson, to date, California and Oregon are the only states that have formally disciplined doctors for the undertreatment of pain, but he anticipates more states will follow if the recommended policy is approved.

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