Does Lyrica (Pregabalin) Require a Pain Management Contract?
No, Lyrica (pregabalin) does not require a pain management contract. Pregabalin is not an opioid and pain management contracts (patient-provider agreements) are specifically recommended for opioid therapy, not for non-opioid adjuvant analgesics like pregabalin.
Why Pain Contracts Are Not Required for Pregabalin
Pain management contracts are specifically designed for opioid prescribing. Professional pain societies and the Federation of State Medical Boards recommend patient-provider agreements (PPAs) when patients with chronic pain are prescribed opioid analgesics, not for non-opioid medications 1.
Pregabalin is classified as an adjuvant analgesic, not an opioid. Guidelines consistently categorize pregabalin alongside gabapentin as anticonvulsant adjuvant analgesics used to enhance pain relief and reduce opioid requirements 1.
Emergency medicine guidelines distinguish opioid contracts from other pain medications. The American College of Emergency Physicians specifically states that pain contracts/treatment agreements should be honored for patients undergoing chronic opioid therapy, with no mention of such requirements for adjuvant medications like pregabalin 1.
Important Caveats About Pregabalin Abuse Potential
While pain contracts are not required, prescribers should be aware of certain considerations:
Pregabalin is a Schedule V controlled substance in the United States, indicating the lowest potential for abuse among controlled substances, but some abuse potential does exist 2.
Case reports document pregabalin-seeking behavior in patients with prior substance abuse history, including doctor shopping and obtaining prescriptions from multiple sources 2.
Research demonstrates that pregabalin can produce reinforcing effects similar to other drugs of abuse in preclinical models, suggesting the abuse potential may be underestimated 3.
Clinical Monitoring Recommendations
Rather than requiring formal pain contracts, appropriate clinical monitoring for pregabalin includes:
Standard medication monitoring with periodic assessment of efficacy (pain reduction, functional improvement) and tolerability (somnolence, dizziness) 1.
Enhanced vigilance in high-risk patients with histories of substance abuse, though this does not necessitate formal opioid-style treatment agreements 2.
Checking prescription drug monitoring programs (PDMPs) when clinically indicated, particularly if aberrant behavior is suspected, though this is not mandated for pregabalin as it is for opioids 1.
When Pain Contracts ARE Required
Pain management contracts should be implemented when: