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A new smartphone app being tested by pain specialists at Brigham and Women’s Hospital in Boston has the potential to help reduce opioid use in chronic pain sufferers, according to an expert who spoke recently at the International Conference on Opioids.
The app is one of several new technological approaches that could impact opioid abuse, says Robert Jamison, PhD, Chief Psychologist at the Pain Management Center at Brigham and Women’s Hospital.
The app, being tested with both cancer and non-cancer patients, is available for the iPhone and Android phones. It tracks patients’ pain data and saves it to their medical record. “This gives doctors a lot more feedback about how patients are doing,” Dr. Jamison said.
The smartphone pain app could help doctors do a better job of assessing potential risk of opioid abuse, he notes. “It will track patients’ use of medications, side effects, improvement in pain and activity,” he explained.
Dr. Jamison and colleagues are conducting a study of the app, and have enrolled 60 patients so far. The app’s users are chronic pain patients, some of whom have cancer. About half of the patients are using opioids.
Patients use the app for three months, and then are given the opportunity to continue using it for another three months. So far, all of the patients have opted to continue using it. Users choose a time of day to get a reminder on their phone to use the app. They use a 1-to-10 scale to rate their pain level in the past 24 hours; how much their pain has interfered with their activity and sleep; and their mood and how much their pain has changed in the past 24 hours. The information is saved and displayed as a line graph so their doctors can track their pain, mood, activity and sleep over time.
The app includes information for pain patients, such as how to reduce stress and relax. Everyone in the study also receives a Fitbit to track activity. In addition, half of the patients in the study receive supportive text messages. “If they are not doing well, we’ll give them ideas about how to manage their pain better,” Dr. Jamison said. A sample message reads, “Hello Fred, it looks like you went through a bad patch. Have you looked at the ‘Topics of Interest’ section? You may find that strategies related to stress and relaxation help with migraines and/or severe bouts of pain. When in doubt, take the next small step.”
Some of the messages provide encouragement, such as “Hello Dave! It looks like your mood and activity interference have improved–way to go! Even if it feels small, every positive counts.”
“Patients will get a sense that someone is really watching and supporting them. We want to find out how much that will make a difference,” Dr. Jamison said. “We also want to see if this app will help keep people out of the ER and reduce their pain.”
This type of information is useful because many primary care physicians feel they need more support in treating chronic pain patients, Dr. Jamison found in a separate study he presented at the conference. The study of 56 primary care physicians and 253 chronic pain patients found many of the doctors fear their patients will become addicted to opioids, and lack confidence in prescribing opioids for chronic noncancer pain. Most of the doctors in the study said they would be willing to treat pain patients if they had support from a pain clinic.
Patients in the study were called once a month for six months to monitor pain and opioid compliance. At the end of six months, there was a reduction in patients taking opioids, and a significant decrease in the number of patients who reported running out of their medication early.