WSR 07-11-059



(Podiatric Medical Board)

[ Filed May 11, 2007, 1:09 p.m. , effective June 11, 2007 ]

Effective Date of Rule: Thirty-one days after filing.

Purpose: The rules set standards when prescribing and treating acute, chronic and intractable pain patients. By establishing rules under treatment of chronic pain may be reduced and access to care enhanced. The rules will alleviate the legal concerns and apprehensions of providers when managing pain patients with opioid therapy.

Statutory Authority for Adoption: RCW 18.22.015, 18.130.050.

Other Authority: Chapters 18.22, 18.130 RCW.

Adopted under notice filed as WSR 06-22-102 on November 1, 2006.

Changes Other than Editing from Proposed to Adopted Version: WAC 246-922-520, a paragraph before subsection (1) was inadvertently left out of the proposed rule that clarifies that the guidelines referenced in subsections (1) through (4) are the September 13, 1996 "Guidelines for Management of Pain" that the board approved. Correcting this omission clarifies the rule without changing its intended effect.

A final cost-benefit analysis is available by contacting Arlene Robertson, P.O. Box 47866, Olympia, WA 98504-7866, phone (360) 236-4945, fax (360) 236-2406, e-mail

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 4, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 4, Amended 0, Repealed 0.

Date Adopted: May 11, 2007.

Blake T. Maresh

Executive Director

for David Bernstein, DPM

Board Chair


WAC 246-922-510   Use of controlled substances for pain control.   (1) Purpose. The podiatric medical board recognizes that effective pain management is an essential component of quality medical care and that no single approach to the treatment of pain is exclusively correct.

(2) The board wishes to reassure podiatric physicians that they need not fear disciplinary action from the board for prescribing, dispensing, or administering controlled substances, including opioids, when treating pain so long as the care provided is consistent with currently acceptable podiatric medical practice. This includes acute, chronic, and intractable pain (RCW 69.50.308(g)) patients.


WAC 246-922-520   What specific guidance should a podiatric physician follow?   The podiatric physician should consult the Guidelines for Management of Pain approved by the podiatric medical board effective September 13, 1996.

(1) The board has adopted guidelines for the management of pain in order to acquaint podiatric physicians with recognized national standards in the field of pain treatment.

(2) These guidelines specifically address the patient evaluation and treatment plan, informed consent, periodic reviews, use of consultations, and the necessity for maintaining accurate and complete medical records.

(3) These guidelines may be revised from time to time to reflect changes in the practice of pain management.

(4) Podiatric physicians who cannot, or choose not to, treat patients who have complex or chronic pain conditions should offer appropriate referrals for those patients.


WAC 246-922-530   What knowledge should a podiatric physician who elects to treat chronic pain patients possess?   Podiatric physicians treating pain should be:

(1) Knowledgeable about the complex nature of pain;

(2) Familiar with the pain treatment terms used in the board's pain treatment guidelines; and

(3) Knowledgeable about acceptable pain treatment modalities.


WAC 246-922-540   How will the board evaluate prescribing for pain?   The podiatric physician's treatment will be evaluated by a review of the provided care to see if it is clinically sound and in accordance with currently acceptable podiatric medical practice regarding the treatment of pain.


Washington State Code Reviser's Office