Las Vegas—Mobile health applications, which improve patient–practitioner communications and facilitate remote assessment and intervention, can extend the reach and efficiency of pain management clinics, according to researchers.

Robert Jamison, PhD, professor of anesthesia and psychiatry at Harvard Medical School and the Pain Management Center at Brigham and Women’s Hospital (BWH), both in Boston, presented an overview of mobile technologies and the applications for pain management, as well as results of utilization studies with their BWH Painapp at the PAINWeek 2017 meeting.

Dr. Jamison suggested that the adoption of the new technologies to improve efficiencies in pain management would not only benefit patients, but could help to reduce the high health care costs associated with chronic pain, which are increasing as the number of elderly people with chronic pain conditions grows.

In fact, chronic pain was associated with expenditures of $560 billion to $635 billion in 2010, matching the combined amount spent on heart disease, cancer and diabetes, according to a report of health care costs.

“If I take two people of exactly the same age, demographics and medical issues, and one has severe chronic pain and the other very minimal pain, the person with severe pain is going to be three times more expensive to manage,” Dr. Jamison said.

New Technologies Apply Traditional Tenets of Healing

An important component of effective management of chronic pain is to have patients actively engage in their own treatment, Dr. Jamison said. “Self-management and patient engagement are essential to successful case management, particularly among patients with high needs and costs. They are associated with improved quality of life, functional autonomy and decreased hospital use.”

Mobile health applications that allow remote data entry can encourage patient engagement, and enable direction to be given remotely based on status updates, Dr. Jamison said. The apps can be used, for example, to prompt for and monitor exercise regimens and mood inventories, as well as to monitor pain level.

However, there are barriers to self-management of chronic pain. These obstacles include inadequate patient education, poor integration of self-management approaches into medical practice, and lack of provider time to implement and monitor new interventions.

Text messaging is one method that can help to reduce such barriers, Dr. Jamison pointed out, by being well accepted and widely used, and being less expensive than phone calls for clinics to use to promote attendance to office appointments and adherence to treatment.

“There’s a lot of evidence that if you can connect people using text messages in your clinic, you can improve satisfaction, you can improve medication compliance, you can connect with patients in a much less expensive and more rapid way,” he said, citing a review from 2012 (Cochrane Database Syst Rev 2012;12:CD007459).

Toward a Better App

Although there are approximately 19,000 health-related apps, mainly for monitoring and obtaining information, relatively few are intended to facilitate interventions for pain, according to Dr. Jamison. Most of the approximately 200 pain-specific applications, including My Pain Diary, Chronic Pain Tracker and CatchMyPain, provide tools for tracking pain.

A 2014 review of the pain applications cited by Dr. Jamison indicated that few of the apps employed evidence-based content and pain management strategies (J Opioid Manag 2014;10:63-68). Another study indicated that none of the apps met all five recommended areas for functionality: self-monitoring, goal setting, skills training, social support and education (Pain Med 2014;15:898-909). Both articles noted there was little evidence of involvement of a health care professional in the development of the app.

“So, in other words, there is a big gap in terms of what they [the reviewers] think should be available and what’s currently available,” Dr. Jamison said.

He pointed out that some apps that enable pain assessment can provide real-time feedback to providers to facilitate treatment strategies, and interactive apps can direct patients to resources and timely self-management techniques. “The benefit, of course, is that if you can send an assessment to a future patient and they complete that information, then you have that information in your clinic before they even come into the door.”

In their study of the BWH Painapp (n=105), Dr. Jamison and his colleagues provided half of the patients with supportive text messages based on their pain status and activity data, whereas they provided only a “message received” text to the other group. The researchers received an average of 18.8 assessments each month (SD, 9.2; range, 0-29) from the study participants. No differences were found between patients with many or few daily entries in age, sex, race or pain site.

Dr. Jamison and his colleagues found that participants with more monthly entries reported greater improvement in pain, mood and activity interference. Those with more frequent entries also reported more satisfaction with the app. One unanticipated finding was that patients with more pain-related disability—marked by more pain-related interference with activity and work—were among those having the highest satisfaction with the app.

Future development of apps for health care and pain management should be guided by the principle that patients want to access a live person, not a robot when they have a medical problem, according to Dr. Jamison. “So this is a challenge in the future about any health care technology. You know that information alone is not enough. You need a program that engages the patients, that’s relational, that motivates them, that can be adaptive and feels like it’s personal, that can be easy to use, that can be fun to use, and demonstrates some sense of caring.”

The BWH Painapp is available to pain management providers at app store download websites.

—Kenneth Bender