Background Chronic low back pain is challenging to manage due to multidisciplinary considerations. It has substantial socioeconomic impacts and cannot be simply treated with pharmacotherapy, nonsurgical intervention, or spine surgery. Medical consensus recommends optimizing conservative self-management therapies (eg, home exercise, wellness strategies, yoga, etc) as first-line treatment options for chronic low back pain. However, access to these modalities is often limited and secondary to cost, convenience, and ease of use. Mobile health apps have emerged as a cost-effective and accessible option for chronic low back pain self-management. Established in-person pain programs can provide the structure for an optimal mobile app adaptation. PainNavigator (PainNavigator, Inc) is an example of a mobile app that is based on an Ascension-Illinois group–based pain program—Pain Rehabilitation Outpatient-Camp. Objective This was a prospective pilot clinical trial that evaluated the PainNavigator platform’s utility in low back pain management to inform future trial development. Methods A total of 75 participants who used PainNavigator were studied. Pain, Enjoyment, and General Activity (PEG-3) scale scores and scores from a brief anxiety and depression scale based on the Patient Health Questionnaire-4 (PHQ-4) were obtained at baseline and following program completion. The PEG-3 total score was used, in addition to individual items—Average Pain, Pain Effect on Enjoyment, and Pain Effect on Activity. The PHQ-4 total score was also used, in addition to other individual items, including Felt Depressed, Loss of Interest, Felt Anxious, and Difficult to Control Worry. Paired sample t tests (2-tailed) compared mean differences in scores from before and after participants received the intervention. Results The analysis found that PEG-3 (n=27) and PHQ-4 (n=27) total scores were significantly lower upon the completion of PainNavigator (P<.001 and P=.001, respectively). The findings showed a 36% reduction in PEG-3 total scores, a 40% reduction in pain intensity, and a 40% reduction in PHQ-4 total scores. Scores for individual PEG-3 scale and PHQ-4 items also significantly decreased. All PEG-3 measures had large effect sizes. The PHQ-4 total score and Difficult to Control Worry item had large effect sizes, while the other three measures had medium effect sizes. Conclusions These findings show that PainNavigator has clinical significance in managing chronic low back pain and can be easily utilized to improve patient care. All PEG-3 scale and PHQ-4 measures significantly improved following the use of the platform, supporting the multidimensional, biopsychosocial approach to low back pain management. Differences in effect sizes may inform quality improvement investigations, such as optimizing features that impact measures with only medium effect sizes. This feasibility study demonstrates an effective protocol, and it will inform future, more extensive randomized controlled trials.

BACKGROUND Chronic low back pain is challenging to manage due to multidisciplinary considerations. It bears substantial socioeconomic impact and cannot be simply treated with pharmacotherapy, nonsurgical intervention, or spine surgery. Medical consensus recommends optimizing conservative, self-management therapies (e.g., home exercise, wellness strategies, yoga, etc.) as first-line treatment options for chronic low back pain. However, access to these modalities is often limited secondary to cost, convenience, and ease of use. Mobile health applications have emerged as a cost-effective and accessible option for chronic low back pain self-management. OBJECTIVE This was a pilot study evaluating the PainNavigator platform to inform future trial development. METHODS 75 participants using PainNavigator were studied. PEG-3 and a brief anxiety and depression scale based on the PHQ-4 scores were obtained at baseline and following program completion. PEG-3 total score was used, in addition to individual items, Average Pain, Pain Effect on Enjoyment, and Pain Effect on Activity. PHQ-4 total score was also used, in addition to the individual items including, Felt Depressed, Loss of Interest, Felt Anxious, and Difficult to Control Worry. Paired sample t-tests compared mean differences before and after participants received the intervention. RESULTS The analysis found that PEG-3 (n=27) and PHQ-4 (n=27) total scores were significantly lower upon completion of PainNavigator (P<.001 and P=.001, respectively). The findings show a 36% reduction in PEG-3 total score, 40% reduction in Pain Intensity, and a 40% reduction in PHQ-4 total score. Individual PEG-3 and PHQ-4 items were also significantly decreased. All measures had medium to large effect sizes. CONCLUSIONS These findings show that PainNavigator has clinical significance in managing chronic low back pain and can be easily utilized to improve patient care. This study will also inform future randomized controlled trials and quality improvement.