A Pilot Comparison of a Smartphone App With or Without 2-Way Messaging Among Chronic Pain Patients

Objectives: The overall aim of this study was to determine the effect of introducing a smartphone pain application (app), for both Android and iPhone devices that enables chronic pain patients to assess, monitor, and communicate their status to their providers. Methods: This study recruited 105 chronic pain patients to use a smartphone pain app and half of the patients (N=52) had 2-way messaging available through the app. All patients completed baseline measures and were asked to record their progress every day for 3 months, with the opportunity to continue for 6 months. All participants were supplied a Fitbit to track daily activity. Summary line graphs were posted to each of the patients’ electronic medical records and physicians were notified of their patient’s progress. Results: Ninety patients successfully downloaded the pain app. Average age of the participants was 47.1 (range, 18 to 72), 63.8% were female and 32.3% reported multiple pain sites. Adequate validity and reliability was found between the daily assessments and standardized questionnaires (r=0.50) and in repeated daily measures (pain, r=0.69; sleep, r=0.83). The app was found to be easily introduced and well tolerated. Those patients assigned to the 2-way messaging condition on average tended to use the app more and submit more daily assessments (95.6 vs. 71.6 entries), but differences between groups were not significant. Pain-app satisfaction ratings overall were high. Discussion: This study highlights some of the challenges and benefits in utilizing smartphone apps to manage chronic pain patients, and provides insight into those individuals who might benefit from mHealth technology.

[1]  G. Huston The Hospital Anxiety and Depression Scale. , 1987, The Journal of rheumatology.

[2]  C. Eccleston,et al.  Smartphone applications for pain management , 2011, Journal of telemedicine and telecare.

[3]  C. Vanderboom,et al.  Feasibility of interactive technology for symptom monitoring in patients with fibromyalgia. , 2014, Pain management nursing : official journal of the American Society of Pain Management Nurses.

[4]  J. Stinson,et al.  Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer , 2012, Journal of medical Internet research.

[5]  Scott R. Bishop,et al.  The Pain Catastrophizing Scale: Development and validation. , 1995 .

[6]  J. Rome Learning to Master Your Chronic Pain. , 1997 .

[7]  J. Smyth,et al.  Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments. , 2010, British journal of health psychology.

[8]  T. T. Haug,et al.  The validity of the Hospital Anxiety and Depression Scale. An updated literature review. , 2002, Journal of psychosomatic research.

[9]  C A Pollard,et al.  The Pain Disability Index: psychometric and validity data. , 1987, Archives of physical medicine and rehabilitation.

[10]  J. Stinson,et al.  “There’s a Pain App for That”: Review of Patient-targeted Smartphone Applications for Pain Management , 2015, The Clinical journal of pain.

[11]  Jaeho Lee,et al.  Developing a Framework for Evaluating the Patient Engagement, Quality, and Safety of Mobile Health Applications. , 2016, Issue brief.

[12]  M. Jensen,et al.  One- and two-item measures of pain beliefs and coping strategies , 2003, Pain.

[13]  R. Jamison,et al.  There ’ s an App for That : Mobile Technology Is a New Advantage in Managing Chronic Pain , 2013 .

[14]  J. Abbott The distinction between randomized clinical trials (RCTs) and preliminary feasibility and pilot studies: what they are and are not. , 2014, The Journal of orthopaedic and sports physical therapy.

[15]  O. Kristjansdottir,et al.  A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial , 2013, Journal of medical Internet research.

[16]  C. Cleeland,et al.  Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases , 1983, Pain.

[17]  Francis J. Keefe,et al.  The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment , 1983, Pain.

[18]  Nathaniel P. Katz,et al.  Comparative study of electronic vs. paper VAS ratings: a randomized, crossover trial using healthy volunteers , 2002, PAIN.

[19]  M. Sullivan,et al.  Catastrophizing, pain, and disability in patients with soft-tissue injuries , 1998, Pain.

[20]  R. de la Vega,et al.  Development and testing of painometer: a smartphone app to assess pain intensity. , 2014, The journal of pain : official journal of the American Pain Society.

[21]  Lee S. Simon RELIEVING PAIN IN AMERICA: A BLUEPRINT FOR TRANSFORMING PREVENTION, CARE, EDUCATION, AND RESEARCH , 2012, Military medicine.

[22]  Lorraine S Wallace,et al.  A systematic review of smartphone applications for chronic pain available for download in the United States. , 2014, Journal of opioid management.

[23]  Amos S Hundert,et al.  Commercially Available Mobile Phone Headache Diary Apps: A Systematic Review , 2014, JMIR mHealth and uHealth.

[24]  Paul P Stork,et al.  A randomized trial of electronic versus paper pain diaries in children: impact on compliance, accuracy, and acceptability , 2004, Pain.

[25]  C. Cleeland,et al.  Pain assessment: global use of the Brief Pain Inventory. , 1994, Annals of the Academy of Medicine, Singapore.

[26]  P. Wall,et al.  Pain mechanisms: a new theory. , 1965, Science.

[27]  A. Stone,et al.  Real-time data collection for pain: appraisal and current status. , 2007, Pain medicine.

[28]  Charmian Reynoldson,et al.  Assessing the quality and usability of smartphone apps for pain self-management. , 2014, Pain medicine.

[29]  R. Jamison,et al.  Electronic diaries for monitoring chronic pain: 1-year validation study , 2001, Pain.