By Melinda Young
Patients experiencing chronic pain could improve their self-care by using a novel, digital pain management tool, according to the results of a recent study.1
The Manage My Pain app was part of a study that included chronic pain participants in both urban and rural pain clinics. Researchers wanted to find out if the app would help with patient care during the COVID-19 pandemic shutdown in which in-person patient visits dropped to a small percentage overnight, explains Hance Clarke, MD, PhD, FRCPC, staff anesthesiologist, director of pain services, and director of GoodHope Ehlers-Danlos Clinic, and medical director of the Pain Research Unit at Toronto General Hospital.
The app gave clinicians data about patients’ pain levels. It proved especially useful during the pandemic when patients were unable to make regular return visits, Clarke says.
App use was voluntary. The researchers found 73.6% of participants agreed to use the app, and 63.4% used the app for at least one month. “Most apps don’t make it past 20% engagement with patients, so this is very attractive to patients,” Clarke notes.
The researchers also found using the app was associated with participants experiencing less pain-related anxiety and lower pain catastrophizing scores. Both pain-related anxiety and catastrophizing can lead to health problems for patients, including misuse of prescription opioids.
“I think the app, in itself, enables a sense of a release of anxiety,” Clarke says. “Over time, they can see trends in terms of what is happening to them, and this leads to reduction in anxiety and rumination. One of the strongest predictors of poor outcomes are people who are high catastrophizers. Someone may ruminate significantly about almost anything, but when they perseverate about pain and can’t get over pending doom and fear, it’s bad.”
Any tactic or technological tool that helps calm psychological symptoms, allowing patients to focus less on negative aspects of pain, likely will lead to more success.
App Helps Self-Management
Self-management is key to success, and using the app appeared to help with that goal. “You have doctors who can help you and give you [treatment], but you need to cope with the pain and live with it to have a more fulfilling life,” Clarke explains. “If a tool can give someone a sense of control, then their overall psychological distress about their condition will be reduced.”
Patients with chronic conditions have been struggling with mental health problems — especially during the pandemic. “Folks were locked in their homes and told not to get out,” he adds.
One of Clarke’s initial goals for using the app was to collect data that could be monitored by case managers or other providers who could contact patients when they saw problematic trends in the data.
“It could be a case management tool,” Clarke says. “We could [use the tool to] say, ‘Let’s reach out to this person and get them in for a visit.’ I don’t know if that’s achievable, but it’s something we could try.”
Patients download the app and follow a brief tutorial on how to set up their profile, including entering their relevant medications and pain conditions. They learn how to enter a pain rating score from zero to 10. After entering their pain level, they are asked to provide additional information, such as details regarding pain location and characteristics.
The tool gives clinicians and providers a pain report showing the patient’s pain trends over a period of weeks or months. Since patients enter their pain levels at a daily prompt by the app, the information collected likely is more accurate than self-reports every six weeks or several months.
The app shows a direct trajectory of patients’ pain trends. “Getting people to engage with these types of tools [helps] with the goal of getting them back to a place that’s closer to their pre-injury place,” Clarke says.
The app’s trend lines also can spot malingerers. If the pain trend does not fluctuate and remains at a steady, high level, then it is possible the person giving this data is not honest about their pain levels. “Most importantly, this app gives people the ability to better understand signs and symptoms and to communicate with their healthcare provider,” Clarke says.
Conversations between patients and providers are richer, with more information than a few simple answers about their chronic issues, he adds.
- Bhatia A, Kara J, Janmohamed T, et al. User engagement and clinical impact of the Manage My Pain app in patients with chronic pain: A real-world, multi-site trial. JMIR Mhealth Uhealth 2021;9:e26528.