Mobile applications for pain management: an app analysis for clinical usage

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Abstract

Background

Pain is the most common and distressing symptom for patients in all clinical settings. The dearth of health informatics tools to support acute and chronic pain management may be contributing to the chronic pain and opioid abuse crises. The purpose of this study is to qualitatively evaluate the content and functionality of mobile pain management apps.

Methods

The Apple App Store and the Google Play Store were searched to identify pain management apps. The inclusion criteria were as follows: (1) that apps include a pain diary function allowing users to record pain episodes, (2) are available in either Apple App Store or Google Play Store, and (3) are available in the English language. We excluded apps if they were limited to only specific forms of pain or specific diseases.

Results

A total of 36 apps met the inclusion criteria. Most of the apps served as pain diary tools to record the key characteristics of pain. The pain diary features of the apps were grouped into nine categories: the recordings of pain intensity, pain location, pain quality, pain’s impacts on daily life, other features of pain, other related symptoms, medication, patients’ habits and basic information, and other miscellaneous functions. The apps displayed various problems in use. The problem of not involving healthcare professionals in app development has not been resolved. Approximately 31% of apps including a pain diary function engaged clinicians in app development. Only 19% involved end-users in development and then only in an ad-hoc way. Only one third of the apps supported the cross-platforms, none of the apps supported clinician access to graphical pain data visualization, none secured HIPAA compliance, and none endorsed the PEG tool for primary care physicians’ chronic pain management.

Conclusions

Most of the 36 pain management apps demonstrated various problems including user interface and security. Many apps lacked clinician and end-user involvement in app development impacting the clinical utility of these apps. We could not find any pain apps suitable for clinical usage despite high demand from clinicians due to the US opioid crisis.

Electronic supplementary material

The online version of this article (10.1186/s12911-019-0827-7) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 23

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CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016.

Deborah Dowell, Tamara Haegerich, Roger Chou (2016)

Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.

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Development and Initial Validation of the PEG, a Three-item Scale Assessing Pain Intensity and Interference

Erin E Krebs, Karl Lorenz, Matthew Bair … (2009)

ABSTRACT BACKGROUND Inadequate pain assessment is a barrier to appropriate pain management, but single-item “pain screening” provides limited information about chronic pain. Multidimensional pain measures such as the Brief Pain Inventory (BPI) are widely used in pain specialty and research settings, but are impractical for primary care. A brief and straightforward multidimensional pain measure could potentially improve initial assessment and follow-up of chronic pain in primary care. OBJECTIVES To develop an ultra-brief pain measure derived from the BPI. DESIGN Development of a shortened three-item pain measure and initial assessment of its reliability, validity, and responsiveness. PARTICIPANTS We used data from 1) a longitudinal study of 500 primary care patients with chronic pain and 2) a cross-sectional study of 646 veterans recruited from ambulatory care. RESULTS Selected items assess average pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G). Reliability of the three-item scale (PEG) was α = 0.73 and 0.89 in the two study samples. Overall, construct validity of the PEG was good for various pain-specific measures ( = 0.60–0.89 in Study 1 and = 0.77–0.95 in Study 2), and comparable to that of the BPI. The PEG was sensitive to change and differentiated between patients with and without pain improvement at 6 months. DISCUSSION We provide strong initial evidence for reliability, construct validity, and responsiveness of the PEG among primary care and other ambulatory clinic patients. The PEG may be a practical and useful tool to improve assessment and monitoring of chronic pain in primary care.

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Smartphone applications for pain management.

Christopher Eccleston, B R Simon Rosser (2010)

Smartphone applications (or apps) are becoming increasingly popular. The lack of regulation or guidance for health-related apps means that the validity and reliability of their content is unknown. We have conducted a review of available apps relating to the generic condition of pain. The official application stores for five major smartphone platforms were searched: iPhone, Android, Blackberry, Nokia/Symbian and Windows Mobile. Apps were included if they reported a focus on pain education, management or relief, and were not solely aimed at health-care professionals (HCPs). A total of 111 apps met the inclusion criteria. The majority of apps reviewed claimed some information provision or electronic manual component. Diary tracking of pain variables was also a common feature. There was a low level of stated HCP involvement in app development and content. Despite an increasing number of apps being released, the frequency of HCP involvement is not increasing. Pain apps appear to be able to promise pain relief without any concern for the effectiveness of the product, or for possible adverse effects of product use. In a population often desperate for a solution to distressing and debilitating pain conditions, there is considerable risk of individuals being misled.

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Author and article information

Contributors

Peng Zhao: peng.zhao@mail.missouri.edu

Illhoi Yoo:

ORCID: http://orcid.org/0000-0003-2536-3660

1 573 882 7642 , YooIL@health.missouri.edu

Robert Lancey: LanceyR@health.missouri.edu

Ebby Varghese: varghesee@health.missouri.edu

Journal

Journal ID (nlm-ta): BMC Med Inform Decis Mak

Journal ID (iso-abbrev): BMC Med Inform Decis Mak

Title: BMC Medical Informatics and Decision Making

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6947

Publication date (Electronic): 30 May 2019

Publication date PMC-release: 30 May 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 106

Affiliations

[1 ]ISNI 0000 0001 2162 3504, GRID grid.134936.a, Informatics Institute, University of Missouri, ; Columbia, MO USA

[2 ]ISNI 0000 0001 2162 3504, GRID grid.134936.a, Department of Health Management and Informatics, , School of Medicine, University of Missouri, ; Five Hospital Dr., CE718 Clinical Support and Education Building (DC006.00), Columbia, MO 65212 USA

[3 ]ISNI 0000 0001 2162 3504, GRID grid.134936.a, Division of General Internal Medicine, Department of Medicine, , School of Medicine, University of Missouri, ; Columbia, MO USA

[4 ]ISNI 0000 0001 2162 3504, GRID grid.134936.a, Department of Physical Medicine and Rehabilitation, , School of Medicine, University of Missouri, ; Columbia, MO USA

Author information

Illhoi Yoo http://orcid.org/0000-0003-2536-3660

Article

Publisher ID: 827

DOI: 10.1186/s12911-019-0827-7

PMC ID: 6543581

PubMed ID: 31146739

SO-VID: cdb96df8-0bbe-43af-b73d-f88f0edebca9

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.