mHealth App No Better Than Usual Care in Managing Chronic Musculoskeletal Pain

Jared Kaltwasser

Patients said they think apps could help pain management, but a study found called the power of mHealth into question.

Mobile health (mHealth) app technology could be used as a pain-management tool, a new study suggests, but the authors found that one particular method did not achieve its goal.

The study adds scientific rigor to efforts to use smartphone apps to help treat chronic pain, an effort that remains a work in progress.

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A team of researchers from several American academic institutions wanted to study whether the use of an app to mediate and personalize pain management would improve outcomes and patient adherence among people with chronic musculoskeletal pain. They divided 215 patients with chronic musculoskeletal pain lasting at least six weeks into two groups. Half (108) were given an mHealth app to help guide their therapy. The other half continued with the standard therapeutic regimen.

After six months, both groups reported reduced pain, but researchers said it made no difference whether a patient was in the control group or the mHealth group. However, 88 percent of participants who used the app said they believe mHealth can be an effective way to help people manage their pain.

In the study, the mHealth app had a variety of functions and capabilities, including reminding patients to take medications and providing daily surveys on symptoms and potential adverse effects. That survey data could then be used by physicians to guide treatment decisions.

Although the primary outcome was to gauge the extent to which each group’s average pain scores changed over time, the study also examined several secondary endpoints. They included, among other things, the patient’s level of trust in the physician, care satisfaction, engagement and medication-related shared decision making.

As with the primary endpoint, the data showed no difference between the two groups for the secondary outcomes, except in one area: Patients on the mHealth plan had improved shared decision-making with regard to their medications.

The study is an example of how researchers can use mobile technology to conduct so-called n-of-1 studies. N-of-1 studies are those with only one patient. Used in this context, the design can help evaluate dozens of personalized treatment plans at one time. Richard L. Kravitz, M.D., M.P.S.H., of the University of California, Davis, said as technology improves, these types of studies will be easier to conduct.

“I think that better software and hardware (including seamless integration and analysis of monitoring devices) will make n-of-1 trials both easier to accomplish and more useful to doctors and patients,” he told Healthcare Analytics News™.

The study is not the first attempt to use smartphone applications to help patients manage pain. A 2017 study in JMIR mHealth and uHealth examined the quality of commercially available apps in managing postoperative pain.

Researchers then found that commercially available apps lacked scientific rigor. Only five of the 10 apps studied were developed with the involvement of a physician, and none was developed with the input of patients. While eight of the 10 apps listed patient education as their primary goal, researchers found that the apps lacked evidence-based information and guidance.

And although few users left reviews for the apps, the average user rating of the 10 products was a 3.6 out of 5.

“There is a need to develop and evaluate comprehensive, theory-based apps to better support patients with pain self-management care following surgery,” wrote the authors, led by Chitra Lalloo, Ph.D., of the Hospital for Sick Children, in Toronto, Canada.

Kravitz’s new study represented a scientific approach to app-assisted pain management. In this case, however, researchers found that while patients found the app useful, it did not significantly improve their pain levels when compared to other pain management methods.

The study, “Effect of Mobile Device-Supported Single-Patient Multi-Crossover Trials on Treatment of Chronic Musculoskeletal Pain,” was published Sept. 4 in JAMA: Internal Medicine.

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