Nursing ASSIGNMENT: EVALUATING LEGAL AND ETHICAL PRESCRIBING PRACTICES FOR PAIN MANAGEMENT

State Practice Environment

It’s essential that NPs and policy makers have a clear understanding of how their state laws and regulations impact their practice. AANP’s interactive State Practice Environment map provides an overview of NP licensure for all 50 states, Washington, D.C. and U.S. territories. For details about the practice environment in a specific state, simply hover your mouse over a state on the map below. 

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Full Practice

Reduced Practice

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Practice Environment Details

Full Practice State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing. Reduced Practice State practice and licensure laws reduce the ability of NPs to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice. Restricted Practice State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care.

State Practice Information

You need to know all the details about NP practice in your state—from signature authority to the number of CE hours required for licensure and beyond. With your AANP membership, you can access quick reference guides on your state to inform yourself and your patients.

See Practice Information by State

DISCLAIMER: The material contained in this is offered as information only and not as practice, financial, accounting, legal or other professional advice. Correspondents must contact their own professional advisors for such advice. 

Updated: 05/2026

Pain Patient Case Scenario 

To Prepare

In this activity you will be presented with a patient case scenario focused on pain management. To prepare for for this case scenario, review the following resources and learning materials to strengthen your understanding of pain management. 

Resources

Review the following resources. You are encouraged to reference these resources as you make decisions in the case.

· Drug Enforcement Administration. (n.d.). Drug Enforcement Administration (DEA).  https://www.dea.gov/(opens in a new tab)

· Drug Enforcement Administration, Diversion Control Division. (n.d.). DEA Diversion Control Division.  https://www.deadiversion.usdoj.gov(opens in a new tab)  

· American Association of Nurse Practitioners. (n.d.). State practice environment.  https://www.aanp.org/advocacy/state/state-practice-environment(opens in a new tab)  

· Denali Rx. (n.d.). Controlled substance quiz.  https://denalirx.com/controlled-substance-quiz/(opens in a new tab)  

· Kaye, A. D., Jones, M. R., Kaye, A. M., et al. (2023). Drug addiction and pain management. Pain Research and Management, 2023, Article PMC11512731.  https://pmc.ncbi.nlm.nih.gov/articles/PMC11512731/(opens in a new tab)  

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Physical Therapy

Chronic musculoskeletal pain affects a significant portion of the adult population and presents complex challenges for healthcare providers. Evidence-based guidelines recommend non-pharmacological interventions as first-line therapies to improve function, reduce pain, and minimize opioid-related risks.

Click on the tabs below to learn more.

PHYSICAL THERAPY

EXERCISE THERAPY

COGNITIVE-BEHAVIORAL THERAPY (CBT)

COMPLEMENTARY MODALITIES

Physical therapy utilizes core strengthening, posture education, and ergonomic modifications to address chronic musculoskeletal pain. Core strengthening improves stability and reduces strain on the musculoskeletal system, while posture education helps patients maintain proper alignment during daily activities. Ergonomic modifications adapt the environment to support healthy movement patterns, reducing pain triggers and promoting long-term functional improvement.

These evidence-based modalities are recommended as first-line therapies for chronic musculoskeletal pain. They improve function, reduce pain, and encourage patient empowerment and self-management, all while avoiding the risks associated with opioid therapy.

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Medication Therapy

Non-narcotic pharmacologic therapies are recommended as first-line options for managing chronic non-cancer pain, aligning with CDC and AAPM guidelines. These include NSAIDs, acetaminophen, muscle relaxers, and gabapentinoids (for neuropathic pain). These medications are effective for nociceptive pain, have minimal risk of addiction, and support multimodal pain management strategies. Opioid therapy is not considered first-line and is not appropriate for ongoing self-medication.

To learn more about each of these options, explore the flip cards below by selecting the icon in the top right corner.

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NSAIDs (such as ibuprofen or naproxen) are effective for non-narcotic pain management, particularly for nociceptive pain. They reduce inflammation and provide significant pain relief. NSAIDs are recommended if there are no contraindications, such as gastrointestinal, renal, or cardiovascular risks.

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Opioid Therapy

Opioid therapy is not a first-line treatment for chronic pain and should only be considered when non-opioid and adjunct therapies have failed. When opioids are indicated, they must be prescribed at the lowest effective dose, preferably using short-acting formulations. Ethical and safe practice requires a treatment agreement and informed consent, documented in the patient’s record. Ongoing therapy demands monthly reassessment of function and pain (not relying solely on pain scores), as well as monitoring through prescription drug monitoring programs (PMP), pill counts, and urine drug screens. Chronic opioid use carries significant risks, including addiction, overdose, and regulatory scrutiny. Self-obtained opioids are illegal and unsafe. Clinicians must conduct thorough risk-benefit assessments and maintain comprehensive documentation throughout therapy.

Select the icons in the image below to learn more about opioid therapy. 

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Interdisciplinary Collaborations

Professional chronic pain management relies on a multimodal and interdisciplinary approach, which has been shown to improve patient outcomes and reduce reliance on opioids. This strategy integrates physical and occupational therapy to enhance movement and functional abilities, while behavioral health specialists support patients with coping strategies, adherence to treatment, and addressing psychosocial factors. Pharmacists play a crucial role in medication reconciliation and patient counseling, ensuring safe and effective pharmacologic therapy. When pain management needs escalate, consultation with primary care providers or pain specialists is essential for comprehensive care coordination. This collaborative model leverages the expertise of multiple disciplines to optimize pain control, promote patient well-being, and minimize risks associated with opioid therapy

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Risks of Opioids Misuse, Addiction, and Overdose 

Patient-centered opioid therapy for chronic pain emphasizes trust, safety, and collaborative decision-making. Clinicians and patients work together to assess risks, monitor progress, and adjust treatment plans regularly to ensure effective and safe pain management.

To learn more, select the tabs below.

TRUST IN PATIENT

SAFE STORAGE AND DISPOSAL 

MEDICATION ACCESS AT WORK

ACTIVE SELF-MANAGEMENT

REST AND OVERUSE RISK

LEGAL IMPLICATIONS

REASSESSMENT OF PAIN AND FUNCTION

AVOIDING NON-PHARMACOLOGIC THERAPIES WHILE ON OPIOIDS

OPIOID USE AND CRAVINGS

FUNCTIONAL OUTCOMES AND PAIN SCORES

ADJUSTING THE TREATMENT PLAN

PRESCRIPTION MONITORING PROGRAM

Clinicians should engage patients in open discussions about opioid use and cravings, verifying medication use through PMP and urine drug screens as indicated; patients should also be encouraged to use non-pharmacologic therapies such as PT/OT, heat/cold, and stretching alongside opioids to improve outcomes.

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Key Legal and Ethical Consideration for Patients Using Opioids

Safe and effective opioid prescribing in clinical practice requires adherence to regulatory standards, ethical principles, and public health priorities. Clinicians must balance patient needs with legal requirements and societal responsibilities, ensuring that opioid therapy is both justified and carefully managed.

Key Points:

· DEA Compliance: Prescribe opioids only after thorough evaluation and documentation, in accordance with federal regulations.

· Prescription Monitoring Programs: Check prescription drug monitoring programs (PDMPs) before issuing opioid prescriptions to prevent misuse and “doctor shopping”. 

· Ethical Prescribing: Balance patient autonomy with the responsibility to minimize risk of harm, using sound clinical judgment.

· Public Health: Limit opioid exposure and prevent diversion to protect both individual patients and the broader community.

· Informed Consent: Ensure patients are fully informed about the risks, alternatives, and expectations associated with opioid therapy.

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