Reducing Frustration and Improving Management of Chronic Pain in Primary Care: Is Shared Decision-making Sufficient?

Excerpt

Despite long-standing efforts to promote productive discussions about chronic pain treatment, these conversations are often still frustrating for both patients and clinicians. These frustrations can be exacerbated when opioids are involved. Shared decision-making, a process in which patients and clinicians share opinions, information, and preferences in an effort to reach mutual agreement on a treatment,¹ is a well-recognized strategy for fostering productive treatment discussions. Policymakers, patient advocates, and medical ethicists have broadly promoted shared decision-making. Consistent with this stance, federal guidelines emphasize the need to involve patients in treatment decisions about chronic pain. Definitions of shared decision-making vary, but the core elements, as defined by the classic Charles et al. model, are 1) at least two parties are involved; 2) both parties participate in decision-making; 3) participants share information, including discussion of treatment options and their potential consequences (e.g., risks/benefits); and 4) both parties agree on the final decision.¹ …