Pain: Yes, There’s an App for That

DENVER — Pain-focused mobile and electronic health apps were associated with improvements in pain intensity and emotional functioning in chronic pain patients, albeit small, according to a systematic review and meta-analysis reported here.

Pain-focused technology was tied to slight but statistically significant effects on pain intensity and depression over short-term and intermediate-term follow-up periods, reported Rajat Moman, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues in presentations at the 2019 American Academy of Pain Medicine meeting.

“With the almost universality of computer and cell phone use, this technology could widely impact patients,” Moman told MedPage Today. “We wanted to better understand how these interventions helped patients with chronic pain.”

Many pain patients see clinicians only once or twice a month, observed Robert Jamison, PhD, of Brigham and Women’s Hospital in Boston, who was not involved with the study.

“One thing innovative technology has offered is the ability to track patients between visits and get more detailed information that is more accurate than asking them to remember their pain, or their sleep, or how physically active they were,” Jamison told MedPage Today.

“It’s hard to know which apps are good ones. And you can have the best program ever but if people don’t use it, then it’s not worth much,” he continued. “Compliance and patient engagement are very important. That’s a key thing: how do you engage patients to be involved in their care enough to keep track of their progress?”

For this analysis, Moman and colleagues searched four databases for randomized controlled trials of adults with chronic, non-cancer pain and electronic interventions that required no clinician contact from 2000 to 2018. They included 17 trials (n=2,496) and chose outcomes based on IMMPACT criteria, classifying outcomes as short-term (≤3 months), intermediate-term (4-6 months), and long-term (≥7 months).

The meta-analysis of pain intensity scores showed:

• Seven studies (n=881) reported short-term pain intensity by numeric rating scale (NRS; a 0 to 10 scale in which 0 is no pain and 10 is the worst possible pain). Among these studies, the standard mean difference (SMD) in scores with short-term treatment was -0.20 (95% CI -0.35 to -0.05, P=0.01)
• Three studies (n=533) reported intermediate-term pain intensity by NRS: SMD -0.18 (95% CI -0.35 to -0.01, P=0.04)
• Two studies (n=354) reported long-term pain intensity and the effect was not significant

Overall, 10 studies reported depression outcomes and four assessed anxiety. The meta-analysis of emotional functioning scores showed:

• Nine studies (n=1,298) reported short-term outcomes of depression: SMD -0.28, (95% CI -0.48 to 0.08, P=0.007)
• Four studies (n=569) reported intermediate-term outcomes of depression: SMD -0.29 (95% CI -0.49, -0.09, P=0.005)
• Anxiety effects were not significant in either the short- or intermediate-term

One study reported depression and one study reported anxiety as long-term outcomes; these were not included in the meta-analysis.

“Our findings illustrate the small but significant impact these interventions can have on patients with chronic pain,” Moman said. “Not only did we see improvement in pain intensity, but also depression and physical functioning [which was reported at a different meeting].”

“Apps are getting better — some now offer relaxation sound files and information that goes along with cognitive behavioral therapy, like problem-solving,” Jamison noted. “There’s a real argument that with less accessibility to therapists, especially those who specialize in pain, innovative technology platforms can offer a definite benefit.”