Shared Decision-Making and Discontinuation of Opioid Therapy for Chronic Pain

Research is needed to measure the effects of shared decision-making (SDM) on discontinuation of opioid therapy for chronic pain.

Target trial emulation.

National pain research registry from September 2016 to January 2024.

A total of 328 patients currently using opioid therapy for chronic low back pain at baseline, including 164 patients each in greater and lesser SDM groups matched on propensity scores.

SDM was measured with the Communication Behavior Questionnaire. Primary outcomes involving discontinuation of opioid therapy and opioid prescribing frequency and secondary outcomes of pain, function, and health-related quality of life were measured over 12 months.

The mean (SD) age of patients was 56.1 (SD, 11.1) years and 239 (72.9%) were female. During 1178 quarterly encounters, greater SDM was associated with less frequent discontinuation of opioid therapy 3 months postbaseline (RR, 0.56; 95% CI, 0.37-0.86; P = .006) and more frequent opioid prescribing 3 to 12 months postbaseline (RR, 1.24; 95% CI, 1.11-1.38: P < .001). Although greater SDM was associated with worse physical function, and opioid therapy was associated with greater back-related disability and worse physical function, these results were not clinically important. SDM x opioid therapy interaction effects were not observed, indicating that more frequent use of opioid therapy with SDM did not yield better outcomes.

SDM was associated with less frequent short-term discontinuation of opioid therapy and more frequent long-term opioid prescribing that was not associated with better outcomes. Thus, SDM is necessary but insufficient to improve opioid prescribing for patients with chronic pain.