Shared decision-making and individual strategies for the patient with chronic pain

PURPOSE OF REVIEW: Chronic pain management increasingly requires a patient-centered, adaptive approach. This review examines how shared decision-making (SDM) and individualized strategies develop and function in chronic pain care, emphasizing their relevance in practice. RECENT FINDINGS: Recent literature highlights that SDM improves patient satisfaction, engagement, and psychological outcomes across various chronic pain conditions. However, SDM is most effective when viewed as an ongoing, iterative process rather than a one-time decision. Studies show that alignment between patient and clinician expectations, effective communication, and recognition of patient preferences are key determinants of success. In opioid management, SDM may unintentionally sustain prescribing patterns, underscoring the need for balanced communication and clinician training. Decision aids and structured tools can support SDM by improving patient knowledge and involvement, although barriers such as health literacy and access to technology remain. Persistent discrepancies between patient and clinician perspectives, as well as contextual and socioeconomic factors, can challenge implementation. SUMMARY: SDM is an essential component of chronic pain management but is insufficient as a standalone strategy. Effective care requires continuous support, education, and adaptation within a strong therapeutic relationship. Future approaches should focus on flexible, context-sensitive interventions that integrate biopsychosocial principles and address individual patient needs.