From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies

Abstract

To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.

Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health

“…As exemplified by RelieVRx and the Kaia Back Pain app, DTx are promising tools to integrate pharmacotherapies with patient education and PT (Figure 6). Opportunities for DTx to be integrated with pharmacotherapies as drug + digital combination therapies have been previously described for chronic pain and epilepsy [33,126,127]. Since digital health technologies can support medication management [128], Opportunities for DTx to be integrated with pharmacotherapies as drug + digital combination therapies have been previously described for chronic pain and epilepsy [33,126,127].…”

“…Opportunities for DTx to be integrated with pharmacotherapies as drug + digital combination therapies have been previously described for chronic pain and epilepsy [33,126,127]. Since digital health technologies can support medication management [128], Opportunities for DTx to be integrated with pharmacotherapies as drug + digital combination therapies have been previously described for chronic pain and epilepsy [33,126,127]. Since digital health technologies can support medication management [128], digital therapeutics can help CLBP patients to support medication dosing, adherence and analgesic tapering while simultaneously providing other therapeutic modalities (e.g., CBT, mindfulness meditation, relaxation) and PT.…”

“…Since both stress and adequate sleep are associated with CLBP [132][133][134][135], development and validation of wearables that can measure stress and sleep [136] can also advance the development of biofeedback-based digital interventions for CLBP. We recently described how DTx can accommodate multiple modalities to yield personalized drug + digital combination therapies ("precision metapharmacology") for people living with chronic diseases, such as chronic pain, epilepsy, depression, and cancer [126]. This approach enables integration of pharmacotherapies with just-in-time adaptive interventions (JITAI), a behavior-change therapy that can adjust content based on a patient's real-time needs and circumstances [137,138].…”

“…For CLPB patients, JITAI can address sedentary behaviors [139][140][141][142] and comorbid depression [143], while seamlessly integrating medication management and the precision delivery of non-pharmacological "active ingredients" (PT, CBT, mindfulness meditation, breathing exercises, education, etc.). Given that adverse childhood experiences (ACE) and traumaassociated mental disorders impact both chronic pain and pain management [144,145], it is noteworthy that DTx have an ability to adjust therapeutic content based on ACE scores and emotions (Figure 1B in [126]). One of the benefits of digital health technologies intended to treat chronic medical conditions is their ability to integrate diverse "active ingredients", and both, RelieVRx and the Kaia Back Pain app are absolute examples of multimodal digital therapies.…”

Healthy Dwelling: Design of Biophilic Interior Environments Fostering Self-Care Practices for People Living with Migraines, Chronic Pain, and Depression

“…“Stay-at-home” restrictions, due to the COVID-19 pandemic, further decreased physical activity, having an adverse impact on mental health [ 5 ]. Lifestyle modifications and self-care practices can help patients to improve their health [ 6 , 7 , 8 ]. For the purpose of this work, self-care is defined as “the ability of individuals, families and communities to promote health, prevent disease, maintain health and to cope with illness with or without the support of a healthcare provider” (definition by the World Health Organization).…”