Patient decision aids for pain medication management: A scoping review

Medications are commonly used to manage pain; however, patients may find it challenging to weigh benefits and harms within the context of their own clinical circumstances, goals, and preferences. Patient Decision Aids (PtDAs) can improve knowledge and engagement in health decisions, yet the nature, content, and quality of PtDAs for pain medication management have not been evaluated.

This scoping review aimed to identify, describe, and appraise PtDAs for pain medication management, including their characteristics and content, and synthesise evidence from primary studies evaluating their use, including effects on decision-making and medication-related outcomes.

A systematic search was conducted across MEDLINE, Embase, PsycINFO, and CINAHL, as well as eight decision aid repositories, and Google. Screening and data extraction were performed in duplicate, capturing target conditions, decision options, formats, and outcomes. PtDAs were appraised using the International Patient Decision Aid Standards instrument (IPDASi) and evaluation studies using the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) checklist.

Thirty-nine PtDAs and 13 evaluation studies were included. PtDAs commonly targeted chronic conditions including osteoarthritis (49%) and back pain (21%), with nonsteroidal anti-inflammatory drugs (77%), corticosteroid injections (74%), and paracetamol (56%) the most frequently included medications. Most PtDAs compared medications to non-pharmacological strategies (e.g., exercise, surgery) but lacked detailed information on safety, effectiveness, and cost. Despite this, randomised controlled trials and pre-post studies generally reported improved knowledge and reduced decisional conflict following PtDA use.

Given the central role of medications in pain management, PtDAs should place greater emphasis on medication-specific content. This review identifies key priorities for PtDA development, including clarifying intended duration of use, distinguishing medications from 'conservative care', and considering treatment costs and burdens. Implementing these recommendations may support the development of tools that better reflect the complexities of pain medication decision-making across the continuum of care.