Purposeful Shared Decision-Making in Caring for and with Patients with Chronic Pain Receiving Opioid Therapy

CDC guidelines for prescribing opioids for chronic pain recommend that patients and clinicians engage in shared decision-making (SDM), a practice often described as clinicians working with patients to find treatment options that match patient preferences. Some experts have argued otherwise given limited efficacy of opioid use for chronic pain, the potential effects of long-term opioid therapy on patient’s decision-making capacity, and the societal consequences of opioid diversion. Chronic pain care involves reaching a shared understanding of how the patient’s pain affects living and how to change this situation. The conversation to achieve this shared understanding and to change the problematic situation of the patient is called Purposeful SDM. Purposeful SDM as a method of collaborative care is a useful and usable framework for patient-centered chronic pain care with or without prescription opioids. Chronic pain or long-term opioid therapy do not render patients unable to participate in Purposeful SDM. And yet, some regulatory tools intended to make opioid prescribing safer, when used punitively, may undermine both the trust that sustains the patient-clinician relationship and the possibility of SDM. There is considerable nuance in chronic pain management and opioid prescribing decisions. The Purposeful SDM framework is based on and contributes to a collaborative, non-punitive relationship between patient and clinician to make chronic pain care fit while avoiding unintended harm from unilateral treatment decisions.