Managing Chronic Pain in an Opioid Crisis: What Is the Role of Shared Decision-Making?

ABSTRACT

Shared decision-making (SDM) is a widely-advocated practice that has been linked to improved patient adherence, satisfaction, and clinical outcomes. SDM is a process in which patients and providers share information, express opinions, and build consensus toward a treatment decision. Chronic pain and its treatment present unique challenges for SDM, especially in the current environment in which opioids are viewed as harmful and a national opioid crisis has been declared. The purpose of this qualitative study is to understand treatment decision-making with patients taking opioids for chronic pain. Ninety-five clinic visits and 31 interviews with patients and primary care providers (PCPs) were analyzed using the constant comparison method. Results revealed that 1) PCPs desire patient participation in treatment decisions, but with caveats where opioids are concerned; 2) Disagreements about opioids, including perceptions of lack of listening, presented challenges to SDM; and 3) PCPs described engaging in persuasion or negotiation to convince patients to try alternatives to opioids, or appeasing patients requesting opioids with very small amounts in an effort to maintain the patient-provider relationship. Results are discussed through the lens of Charles, Gafni, and Whelan’s SDM model, and implications of the role of the patient-provider relationship in SDM and chronic pain treatment are discussed.

Acknowledgments

The authors would like to thank Stephen Henry, M.D., for comments on an earlier version of this manuscript.

Disclosure of potential conflicts of interest

The authors declare no conflicts of interest.

Additional information

Funding

This research was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number 1R21DA037384-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.