Impact of Shared Decision-Making on Opioid Prescribing Among Patients With Chronic Pain: A Retrospective Cohort Study

John C Licciardone; Braden Van Alfen; Michaela N Digilio; Rylan Fowers; Bassam Ballout; Yasser Bibi; Subhash Aryal

doi:10.1016/j.jpain.2024.03.018

Impact of Shared Decision-Making on Opioid Prescribing Among Patients With Chronic Pain: A Retrospective Cohort Study

J Pain. 2024 Apr 12:104522. doi: 10.1016/j.jpain.2024.03.018. Online ahead of print.

Authors

John C Licciardone¹, Braden Van Alfen¹, Michaela N Digilio¹, Rylan Fowers¹, Bassam Ballout¹, Yasser Bibi¹, Subhash Aryal²

Affiliations

¹ University of North Texas Health Science Center, Fort Worth, Texas.
² Johns Hopkins University, Baltimore, Maryland.

PMID: 38615802
DOI: 10.1016/j.jpain.2024.03.018

Abstract

Shared decision-making (SDM) involving patient and physician is a desirable goal that is recommended in chronic pain management guidelines. This study measured whether SDM affects opioid prescribing frequency for chronic low back pain. A retrospective cohort study involving 1,478 participants was conducted within a national pain research registry. The patient participation and patient orientation (PPPO) scale of the Communication Behavior Questionnaire was used to measure SDM, including the classification of greater SDM (PPPO scale score ≥ 80) or lesser SDM (PPPO scale score < 80). Opioid prescribing frequency was measured at quarterly intervals from enrollment through 12 months. Baseline and longitudinal covariates were collected to adjust for potential confounding using generalized estimating equations. The mean age of participants was 53.1 (SD, 13.2) years, and 1,098 (74.3%) were female. A total of 473 (32.0%) participants were prescribed opioids at baseline. Participants completed 5,968 encounters wherein multivariable analyses demonstrated that PPPO scale scores were associated with more frequent opioid prescribing (β = .013; 95% CI, .005-.021; P < .001). Greater SDM was associated with more frequent opioid prescribing than lesser SDM (β = .441; 95% CI, .160-.722; P = .002). Opioids were prescribed in 34.3% versus 25.2% of encounters with greater versus lesser SDM (OR, 1.55; 95% CI, 1.17-2.06). SDM remained associated with more frequent opioid prescribing in a series of sensitivity analyses. Although SDM is desirable in chronic pain management, complex issues and challenging patient conversations may arise during serial assessments of the appropriateness of opioid therapy. Physicians need better education and training to address such difficult situations. PERSPECTIVE: The more frequent use of opioid therapy among patients who reported greater SDM with their physicians underscores the need for better medical education and training in dealing with the complex issues and challenges pertaining to serial assessments of the appropriateness of opioid therapy for chronic pain.

Keywords: Shared decision-making; chronic pain; opioid therapy; pain research registry; retrospective cohort study.