People with chronic pain can reliably manage their symptoms with mobile health. Researchers from Brigham and Women’s Hospital provided pilot data for an emerging concept: using mobile health to manage chronic pain. Jamison & Jureik et. al published the article “A Pilot Comparison of a Smartphone App with or without 2-way Messaging Among Chronic Pain Patients: Who Benefits From a Pain App?”. This article provided evidence that relying on mobile health to manage chronic pain is feasible and valid.
Brigham and Women’s Hospital is a Harvard affiliated teaching hospital in Boston that offers specialty services for the management of pain. Patients who require specialists for complex pain control are usually managed by these pain clinics. Traditional methods relied on anesthesiology techniques to reduce pain, but the practice has evolved into a multidisciplinary team approach. Providers are typically physicians who have completed fellowship training in Clinical Pain Medicine, and lead an integrative medical team providing physical therapy, psychotherapy, and social support to provide biofeedback during treatment. The authors of this study are faculty from the Anesthesia and Pain Management department.
Pain is a complex issue that has recently been in the forefront of American news. Deaths from drug overdoses are now the leading cause of accidental death in America, with the majority arising from abuse of opiate pain medications prescribed by doctors. This rising epidemic of abuse has been blamed by many on the mismanagement of chronic pain by the medical establishment. People who experience pain consistently for six months have chronic pain. Sometimes there are no clear causes to this syndrome, and the symptoms are complex in its management. Even when the cause is diagnosed, many patients are refractory to treatment by pain specialists. The medical community is reviewing its ways of treating chronic pain due to rising deaths from the opioid epidemic, and mobile health is a potential tool for healthcare providers to improve pain. With the prevalence of smartphones in the community, there is potential through innovation in mobile health to affect change in a segment of the population that has been refractory to conventional methods.
This paper summarizes these reviews, pointing out that the majority of these apps were not developed with healthcare professional involvement and do not offer all the features that would be ideal in pain management.
There have been review articles published in the medical literature on apps that manage chronic pain. This paper summarizes these reviews, pointing out that the majority of these apps were not developed with healthcare professional involvement and do not offer all the features that would be ideal in pain management. The authors developed an app that had three major categories of function: providing evidence-based information about pain, a diary for tracking progression, and interventions for pain management. 105 chronic pain patients were recruited to use the smartphone app on either an iOS or Android device. Half of the participants were randomized to use a 2 way messaging feature of the app, where a research assistant gave weekly feedback and supportive text messages. The control group received an automated reply if the message feature was used. Additional features included tracking demographic information, comprehensive pain assessments using a body map, push notification reminders for assessments, goal setting, and management strategies for pain. A FitBit was given to each participant to measure activity, but there were some issues with adhering to daily use. All subjects were asked to record daily progress on pain levels, activity, sleep, and mood for 3 months. 90 participants were able to successfully use the app and 82 provided daily reports for the required 3 month study period. In the end, 63 completed the last survey which assessed satisfaction with the app. Ten pain management providers were also asked to complete satisfaction surveys at the end of the trial.
The overall results were that both providers and patients found the app to be usable, valid, reliable, and easy to use. Subjects that used the 2 way messaging features used the app more and completed more daily assessments, but no significant differences in pain, activity, and mood were found between the two groups. Subjects with 2 way messaging also felt the app was more appealing and easy to navigate when compared to the control group without this feature. One interesting result was that users who could use 2 way messaging felt like the providers were less responsive when compared to the control group. 27 subjects were able to log daily activity with the Fitbit for the required 3 month period. No differences in activity level were found. This was a thorough pilot study that provided good data that suggests mobile health can be used in a reliable way that is appealing to users and healthcare providers.
Subjects with 2 way messaging also felt the app was more appealing and easy to navigate when compared to the control group without this feature.
This is a pilot study in an area of developing research where there is a paucity of data. This article sets the stage for future researchers to study whether a medical app can improve pain and activity for these patients. The concept of using 2-way messaging in the management of patients was also another feature I found interesting. The results suggest that people who are provided this feature expect a standard level of responsiveness. If their standards are not met, there can be a detrimental effect for users more than if this feature was not provided at all.
There has been a steady increase in mobile applications developed to manage conditions, but relatively few research data exists to validate their effectiveness. This pilot study was thorough and well designed to provide convincing data that using mobile health to manage chronic pain is feasible. These results increase our understanding of how technology can be used to manage chronic conditions. Future studies will need to be done to help developers and healthcare professionals understand what aspects of mobile health are useful to improve pain. In a disease such as chronic pain, multiple disciplines are needed for treatment, which is difficult to efficiently achieve in the clinic environment. The need for innovations in mobile health comes during a time when some have equated the opioid epidemic to the HIV epidemic in the 90s. As an emergency provider who sees the devastating effects of chronic pain mismanagement and deaths from opioid abuse, it is encouraging to see potential solutions coming down the pipeline in mobile health.