Intraoperative pain management shared decision making with a patient with a complex pain and mental health history: A case report

Shared decision making is where the patient and clinician come together to decide on the appropriate course of action in a patient's medical care based on their goals, preferences, and values. Typically, decision making in anesthesia remains more paternalistic, with clinicians making decisions for patients. However, there is a move towards embracing a shared decision making model. We present here a case report of using shared decision making principles to develop a pain and anxiety management plan in a patient with chronic pain and a complex mental health history. A 40-year-old female with a history of chronic pain, bipolar disorder, generalized anxiety disorder, and postural orthostatic tachycardic syndrome presented for elective temporomandibular joint replacement. Exploration of her prior anesthetic and pain experiences led us to co-create a tailored pain and anxiety management plan drawing on our clinical knowledge and her preferences and experiences. She expressed a high level of satisfaction with pain management and overall anesthetic care. Shared decision making can be a powerful tool in creating perioperative pain management plans. While there are calls for increased use of shared decision making in anesthesia care, most research is in the space of high-risk patients and decisions around anesthetic technique. However, in applying the principles of shared decision making to a lower risk patient's pain management plan, we were able to better balance pain management, perioperative anxiety, and medication side effects according to her preferences. More research is needed to promote shared decision making throughout anesthesia care.