The treatment of acute pain over the years has changed with increasing alternative therapies and increased scrutiny of opioid prescriptions. Shared Decision Making (SDM) has become a vital tool in increasing patient engagement and satisfaction in treatment decisions. SDM has been successfully implemented in the management of pain in a variety of settings; however, information regarding the use of SDM for treating acute pain in patients with a history of opioid use disorder (OUD) remains scarce. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR), we conducted a review to understand how SDM is used in acute pain management in patients with OUD. We searched Medline, Embase, CINAHL, and PsychInfo databases for relevant articles. Articles were screened and SDM outcomes of eligible articles were charted. The results were grouped by sub-theme based on a 1997 SDM model. There were three original research studies and one quality improvement study. The remaining articles were split evenly between reviews and reviews of clinical guidelines. Four themes emerged from the review: prior judgment and stigma related to OUD, trust and sharing of information, clinical tools, and interprofessional teams. This scoping review consolidated and expounded the current literature on SDM in the management of acute pain in patients with OUD. More work is needed to address prior judgments by both providers and patients and to build greater dialogue. Clinical tools may aid this process as well as the involvement of a multidisciplinary team.

Introduction: Epidural steroid injections (ESIs) are a common interventional treatment for managing spinal pain complaints. Despite their widespread use, practice patterns among physicians performing ESIs vary significantly. This study aimed to evaluate preprocedural imaging review by pain physicians who perform ESIs in the cervical, thoracic, and lumbar spine. Methods: A survey was distributed to a cohort of physicians who regularly perform ESIs. The survey comprised questions regarding preprocedural imaging review before performing ESIs in the cervical, thoracic, and lumbar spine. The respondents included a diverse group of pain management physicians from various specialties and practice settings. Results: The results revealed that the majority of interventional pain management physicians personally interpret their own imaging, followed by a significant percentage of physicians who rely on the radiology reports. There were no physicians who did not perform any imaging review prior to ESIs. Whereas all respondents reported some form of imaging review, only 63.86%, 53.75%, and 64.44% reviewed the actual images prior to cervical, thoracic, and lumbar access, respectively. Conclusions: This survey provides initial data regarding imaging reviews among physicians who perform ESIs. Our results demonstrate that physicians treat imaging review as an essential component of the preprocedural process for performing ESIs, as all physicians reported that they perform some form of imaging review before performing ESIs. However, there is only partial adherence to the multidisciplinary working group opinion that segmental imaging should be reviewed for adequacy of space prior to cervical epidural access.