Telemonitoring in Chronic Pain Management Using Smartphone Apps: A Randomized Controlled Trial Comparing Usual Assessment against App-Based Monitoring with and without Clinical Alarms

Abstract

Background. The usefulness of mHealth in helping to target face-to-face interventions for chronic pain more effectively remains unclear. In the present study, we aim to test whether the Pain Monitor mobile phone application (app) is well accepted by clinicians, and can help improve existent medical treatments for patients with chronic musculoskeletal pain. Regarding this last goal, we compared three treatment conditions, namely usual treatment, usual treatment with an app without alarms and usual treatment with an app with alarms. All treatments lasted one month. The three treatments were compared for all outcomes, i.e., pain severity and interference, fatigue, depressed mood, anxiety and anger. Methods. In this randomized controlled trial, the usual monitoring method (i.e., onsite; n = 44) was compared with daily ecological momentary assessment using the Pain Monitor app—both with (n = 43) and without alarms (n = 45). Alarms were sent to the clinicians in the presence of pre-established undesired clinical events and could be used to make treatment adjustments throughout the one-month study. Results. With the exception of anger, clinically significant changes (CSC; 30% improvement) were greater in the app + alarm condition across outcomes (e.g., 43.6% of patients experienced a CSC in depressed mood in the app + alarm condition, which occurred in less than 29% of patients in the other groups). The clinicians were willing to use the app, especially the version with alarms. Conclusions. The use of apps may have some benefits in individual health care, especially when using alarms to tailor treatments.

Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings

“…By attending to these data, the use of apps might be feasible to implement EMA in BTcP management. Additionally, as indicated in past research, the use of such apps for EMA could facilitate the implementation of clinical alarms embedded in the app, which could help to detect and respond to undesirable events (e.g., side effects of the medication or treatment non-adherence), which could ultimately improve quality of life in this population [ 38 ].…”

“…Therefore, in the present study, we decided to use Pain Monitor, a validated app for the EMA of pain and related outcomes (e.g., fatigue, mood, and coping) [ 45 ]. The app, which was recently tested in a randomized controlled trial [ 38 ], involved pain experts in its development, was tested for interface problems (patient acceptability), and follows the current regulations in terms of data safety [ 45 ].…”

Using Information and Communication Technologies (ICT) for Mental Health Prevention and Treatment

“…Two of the studies included in this Special Issue focus on how ICT tools can be helpful in the screening and monitoring of different symptoms. Suso-Ribera et al [ 11 ] examined if the Monitor de Dolor app—which allows daily assessment of pain through ecological momentary assessments—would be an effective option for patient monitoring, in terms of improvement of chronic musculoskeletal pain management. The authors performed a randomized controlled trial in which they compared three conditions: the usual monitoring method (onsite retrospectively), usual monitoring plus app without alarms, and usual monitoring plus app with predefined alarms sent to clinicians to make treatment adjustments.…”

An Interactive Pain Application (MServ) Improves Postoperative Pain Management

“…Applications with clinician notification can improve outcomes for patients with chronic pain [ 28 ], but similar results have emerged in hospitalised patients. We had hypothesised that having access to a device to self-report pain would lead to improved analgesia by improving staff responsiveness, with a more marked effect when a specialist pain team was alerted [ 45 ].…”

“…Bespoke treatment on the basis of user feedback represents an exciting opportunity to improve patient care. Suso-Ribera and colleagues showed that alerting clinicians to adverse symptoms entered remotely by patients with chronic pain led to a clinically significant improvement in a range of outcomes including depression, anxiety, pain interference, and severity when compared to usual treatment [ 28 ].…”