Shared decision-making (SDM) approach involves both patients and clinicians in decision-making about possible treatment options, using patients’ preferences and best available evidence. SDM is the delivery of patient-centered care, the practice of evidence-based medicine, and changes the traditional medical decision-making process. It is associated with increased patient satisfaction, involvement, and confidence with healthcare decisions. A nationwide SDM program has been implemented in different medical subspecialties under the support of the Ministry of Health and Welfare since 2016, incorporating multiple approaches such as developing patient decision aids (PDAs). There is still room for improvement in anesthesia and perioperative care. Shared decision-making is an important component of improved patient outcomes and enhanced recovery after surgery (ERAS). Poor management of postoperative acute pain can contribute to medical complications, hinder postoperative recovery, and lead to chronic pain. As pain is subjective, the expectation of analgesia is diverse among individuals. The decision of pain management options may be influenced by the route of analgesics administration, potential side effects, and health insurance coverage. This article reviewed the application of SDM in postoperative pain management, discussed current strategies, common difficulties, and potential clinical solutions.