Journal of Pain publishes a key study from TCOM’s Dr. John Licciardone about the impact of shared decision-making on opioid prescribing for chronic pain

November 11, 2024
By: Steven Bartolotta
Community

Students from the Texas College of Osteopathic Medicine’s Honors Research Practicum course, led by John Licciardone, DO, MS, MBA, FACPM, executive director of the Osteopathic Research Center and regents professor, reported a surprising finding in a study that was published by the Journal of Pain in its November issue.

The article is titled “Impact of Shared Decision-Making on Opioid Prescribing Among Patients with Chronic Pain: A Retrospective Cohort Study,” and included investigators from TCOM’s Class of 2026, Bassam Ballout, Yasser Bibi, Michaela Digilio, Rylan Fowers and Braden Van Alfen along with Subhash Aryal, PhD, a registry biostatistician affiliated with Johns Hopkins University.

The article is based on national data collected by the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) at The University of North Texas Health Science Center at Fort Worth.

The study found that patients who reported greater shared decision-making with their physician at the time of enrollment in the registry more often received opioid prescriptions for chronic low back pain over 12 months of follow-up.

“We have not studied this before, but this finding is contrary to what we expected and in contrast to CDC guidelines on opioid prescribing for chronic pain which recommend SDM as a measure to help minimize unnecessary opioid prescribing for those patients in which it is no longer providing more benefit than harm,” Licciardone said. “Our results should not be interpreted as evidence for abandoning shared decision-making, but rather as a clarion call for improving it.”

The findings could have important implications given concerns about long-term opioid use for chronic pain. Despite policy initiatives to promote shared decision-making during medical encounters, ethicists, clinicians, and researchers worry that common applications of shared decision-making may be premature and have unintended consequences.

Historically, shared decision-making was generally limited to discrete, one-time treatment decisions, such as whether to have elective surgery or choose among cancer treatment options.

“Our study underscores important public health issues involving opioid prescribing for chronic pain, including the need for better medical education and physician training to deal with the complexities of ongoing chronic pain management,” Licciardone said. “Most physicians probably know that long-term opioid therapy for chronic pain is generally not effective. However, they may often lack the communication skills or time to adequately convey this information to patients in a manner that can be readily understood and accepted by them.”

The research and published article demonstrate how the Honors Research Practicum course extends the development of osteopathic medical students beyond traditional educational norms by enabling them to conduct clinical research on important issues that inform contemporary patient-centered care in the United States.

“This research being published is meaningful because the opioid crisis is an iatrogenic epidemic,” Digilio said. “I believe it is our responsibility as future health care providers to investigate opioid usage and prescription and look for ways to mitigate the opioid crisis while still keeping ethics and justice on the front line. This article uncovered an interesting phenomenon that increased shared decision-making leads to more frequent opioid prescriptions, therefore suggesting physicians need better training in shared decision-making.”