Prescribing practice patterns for chronic pain matter more than ever

Chronic nonmalignant pain can be problematic to treat successfully. That sort of pain doesn’t just affect a patient’s body—it touches their work, relationships, sleep, and sense of identity.

Tennessee citizen suffering from chronic nonmalignant pain.

In Tennessee, where opioid addiction has devastated families and communities, prescribing practice patterns for chronic pain matter more than ever.

Tennessee prescribers of controlled substances can reduce the risks of treating chronic pain by completing education on the Tennessee Chronic Pain Guidelines. This education isn’t just a regulatory requirement, it’s also a way to understand and apply best prescribing practices. By knowing the Guidelines, you'll help ensure you prescribe legally while also providing the best care for your patients that also reduces addictions and death in our State.

What the Tennessee Chronic Pain Guidelines Require

If you’re considering prescribing opioids for chronic nonmalignant pain, the guidelines lay out a clear process:

• Physical examinations must go beyond “where does it hurt?” You should document:

  • The nature and intensity of the pain

  • Past and current treatments tried

  • How the pain affects the patient’s daily life—from sleep to recreation to work

• Co-morbid conditions like COPD, sleep apnea, diabetes, or heart failure must be identified. These directly affect opioid safety and efficacy.

• Screening for mental health and substance use disorders is mandatory. Depression, anxiety, or a history of substance use disorder can change everything about how you approach treatment.

As Dr. Nora Volkow, Director of NIDA, has said:

“Treating pain with opioids without addressing underlying mental health or substance use issues is like throwing gasoline on a fire.”(Volkow, NIDA, 2020)

Benzodiazepines + Opioids = A Regulatory Red Flag

The Guidelines are explicit: avoid prescribing benzodiazepines in combination with chronic opioid therapy.

• The risk of overdose skyrockets when the two are combined. One large cohort study found that patients receiving both had a 10-fold higher risk of overdose death compared to opioids alone (Park et al., BMJ 2015).

• Regulators pay close attention to prescribing this combination of medications. In Tennessee, if your patient is on >120 MME of opioids and benzodiazepines, you must refer them to a mental health professional for review of benzodiazepines, buprenorphine, and naloxone.

Doing this isn’t optional. It’s the law.

Documentation: Your First Line of Defense

The Tennessee Board of Medical Examiners treats its chronic pain guidelines as enforceable.

That means:

• Thorough documentation isn’t just good practice—it’s protection for your license.

• Every note in the medical record should reflect the examination, co-morbid condition assessment, mental health screening, and justification for ongoing opioid therapy.

If you don’t document it, regulators will assume you didn’t do it.

Why Knowing the Tennessee Chronic Pain Guidelines Matters

Here’s the reality:

• Tennessee continues to rank among the top 5 states for opioid prescribing rates (CDC, 2023).

• Prescription opioids are involved in nearly 40% of overdose deaths in the state (Tennessee Dept. of Health, 202).

The Chronic Pain Guidelines are designed to help prescribers reduce those numbers—while still providing high quality care for patients with legitimate pain.

Chronic pain management in Tennessee comes with real risks—for your patients and for your license. The best way to protect both?

Know the chronic pain guidelines. Apply them. Document everything.

[Enroll in the free Tennessee Chronic Pain Guidelines education here.]

Because when prescribers know more, Tennessee has a fighting chance at no more unnecessary opioid addictions and deaths.