Patient Preferences for Non-Opioid Regimens in Chronic Non-Cancer Pain: A Systematic Review of Discrete Choice Experiments

Chronic non-cancer pain is highly prevalent, and concerns about long-term opioid harms have increased interest in non-opioid therapies. Understanding which treatment attributes patients value is essential for shared decision-making. This systematic review synthesised discrete choice experiments (DCEs) to identify the treatment attributes patients prioritise when choosing non-opioid regimens for chronic non-cancer pain, and to appraise the methodological quality of the underlying studies. Following PRISMA 2020 guidance and a prospectively registered protocol (PROSPERO CRD420251273180), we searched nine databases (MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, EconLit, PubMed and the Cochrane Library). Two reviewers independently screened records and assessed methodological quality using a modified ISPOR Conjoint Analysis Good Research Practices checklist. Attributes were classified using the Sain et al. (2020) framework into outcome, process and cost categories, and synthesised narratively. Seventeen studies (1,540 records identified) met the inclusion criteria, encompassing 109 attributes; 88% were industry-funded. Outcome attributes predominated (67.9%), followed by process (25.7%) and cost (6.4%). Clinical effectiveness was the most influential attribute, identified as the primary priority in 57.1% of studies combining all three categories, with safety acting as a key differentiator and cost as a constraint. Most studies met ISPOR standards (scores 10.5 to 12), though visual aids (71%) and direct patient input (18%) were underused. Patients prioritise clinical benefit when choosing non-opioid pain therapies, informing preference-sensitive decision-making, clinical guidelines and health technology assessment.