Preferences for shared decision making in chronic pain patients compared with patients during a premedication visit

LAY SUMMARY Medical cannabis is increasingly used by Canadian Veterans to manage chronic pain; however, the benefits and harms are uncertain. This commentary summarizes a recent guideline that found small to very small benefits of medical cannabis for pain relief, physical functioning and sleep quality, and evidence for a small to very small increase in several transient harms. The close balance between benefits and harms supports shared decision-making with Veterans living with chronic pain to ensure the decision whether to pursue a trial of medical cannabis is consistent with their values and preferences.

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Discussions between patients with chronic pain and their primary care provider about opioids and pain relief during routine clinic encounters

Journal of Opioid Management ◽

10.5055/jom.2019.0495 ◽

2019 ◽

Vol 15 (2) ◽

pp. 137-146

Author(s):

Mayra Massey, MMFT ◽

Carissa Carissa van den Berk Clark, PhD, MSW ◽

Jocelyn Fowler, MMFT ◽

Jeffrey F. Scherrer, PhD

Keyword(s):

Primary Care ◽

Decision Making ◽

Chronic Pain ◽

Pain Relief ◽

Shared Decision Making ◽

Care Provider ◽

Primary Care Provider ◽

Shared Decision ◽

Difficult Conversations ◽

Noncancer Pain

Objective: Existing studies indicate low levels of trust and shared decision making exist in the process of prescribing opioids for noncancer pain. Patient-provider communication has not been compared between patients receiving non-opioid pain medication, and those receiving opioids. This pilot study evaluated communication about pain management between patients with noncancer pain and their provider.Design: Patient encounters with a primary care provider (PCP) were audiorecorded, followed by a short patient questionnaire to measure physician trust, depression, and anxiety.Setting: Data were collected (October 2016-May 2017) at a primary care clinic in Saint Louis, MO.Patients: Patients with noncancer chronic pain, receiving a nonsteroidal anti-inflammatory drug (NSAID) or an opioid with and without an NSAID.Methods: Medical conversation analysis guided data interpretation of codes and themes.Results: Themes were framed around stages of the routine PCP encounter (ie, opening, presenting complaint, examination, diagnosis, treatment, and closing). Themes within these stages included: managing stability (opening stage), fixation with pain (presenting complaint), changing the subject (examination stage), difficult conversations (diagnosis stage), patients chose protest or acceptance (treatment), and taking what you can get (closing).Conclusions: Much of the treatment of chronic pain, as a result of opioid prescriptions, revolves around negotiations about whether to use opioids or not. Patient education is required to disseminate realistic expectations regarding pain relief and risks of long-term opioid use. This may reduce patients’ focus on pain severity and difficult conversations and increase shared decision making.

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Opioid Prescribing in Stigmatized and Special Populations

10.1093/med/9780199981830.003.0009 ◽

2018 ◽

Author(s):

Kelly K. Dineen

Keyword(s):

Decision Making ◽

Chronic Pain ◽

End Of Life Care ◽

Vulnerable Groups ◽

Special Populations ◽

Opioid Prescribing ◽

The Past ◽

Chronic Pain Patients ◽

Pain Patients

There is no question that a lack of careful decision-making around opioid prescribing in the past contributed to the current opioid-related harms. Yet opioids—usually in combination with other treatments—are sometimes the only effective therapies for certain chronic pain patients, in whom the benefits of opioids outweigh the risks of a substance use disorder. This chapter examines special populations such as those with sickle cell disease or those experiencing pain in end-of-life care. Caring for chronic pain patients can be challenging, especially now that the use of opioids for long-term pain control has been called into question. This chapter draws attention to attitudes and biases that may contribute to decision-making errors on the part of providers who are trying to balance the benefits and harms of opioids when treating these particularly vulnerable groups.

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Chronic pain patients are impaired on an emotional decision-making task

Pain ◽

10.1016/j.pain.2003.12.015 ◽

2004 ◽

Vol 108 (1) ◽

pp. 129-136 ◽

Cited By ~ 318

Author(s):

Vania A. Apkarian ◽

Yamaya Sosa ◽

Beth R. Krauss ◽

Sebastian P. Thomas ◽

Bruce E. Fredrickson ◽

...

Keyword(s):

Decision Making ◽

Chronic Pain ◽

Chronic Pain Patients ◽

Pain Patients

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Altered social decision making in patients with chronic pain

Psychological Medicine ◽

10.1017/s0033291721004359 ◽

2021 ◽

pp. 1-10

Author(s):

Alicja Timm ◽

Tobias Schmidt-Wilcke ◽

Sandra Blenk ◽

Bettina Studer

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Chronic Pain ◽

Healthy Controls ◽

Social Inequity ◽

Social Decision ◽

Chronic Pain Patients ◽

Social Decision Making ◽

Pain Patients

Abstract Background Chronic pain affects up to 20% of the population, impairs quality of life and reduces social participation. Previous research reported that pain-related perceived injustice covaries with these negative consequences. The current study probed whether chronic pain patients responded more strongly to disadvantageous social inequity than healthy individuals. Methods We administered the Ultimatum Game, a neuroeconomic social exchange game, where a sum of money is split between two players to a large sample of patients with chronic pain disorder with somatic and psychological factors (n = 102) and healthy controls (n = 101). Anonymised, and in truth experimentally controlled, co-players proposed a split, and our participants either accepted or rejected these offers. Results Chronic pain patients were hypersensitive to disadvantageous inequity and punished their co-players for proposed unequal splits more often than healthy controls. Furthermore, this systematic shift in social decision making was independent of patients’ performance on tests of executive functions and risk-sensitive (non-social) decision making . Conclusions Our findings indicate that chronic pain is associated with anomalies in social decision making (compared to healthy controls) and hypersensitivity to social inequity that is likely to negatively impact social partaking and thereby the quality of life.

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