Smartphone Applications Designed to Improve Older People's Chronic Pain Management: An Integrated Systematic Review.

(1) Background: Older people's chronic pain is often not well managed because of fears of side-effects and under-reporting. Telehealth interventions, in the form of smartphone applications, are attracting much interest in the management of chronic diseases, with new and evolving approaches in response to current population demographics. However, the extent to which telehealth interventions may be used to promote and effect the self-management of chronic pain is not established. (2) Aim: To provide an objective review of the existing quantitative and qualitative evidence pertaining to the benefits of smartphone applications for the management of chronic pain in older people. (3) Methods: A literature search was undertaken using PubMed, Medline, CINAHL, Embase, PsychINFO, the Cochrane database, Science Direct and references of retrieved articles. The data were independently extracted by two reviewers from the original reports. (4) Results: This integrative systematic review identified 10 articles considering smartphone applications related to self-management of chronic pain among older adults. (5) Conclusions: It is important for future research to not only examine the effects of smartphone initiatives, but also to compare their safety, acceptability, efficacy and cost-benefit ratio in relation to existing treatment modalities.

Assessing pain intensity following spinal cord injury: should rating scales measure 'overall' or 'maximal' values?

Rating scales (RSs) are important for the assessment of pain intensity (PI) following a spinal cord injury (SCI). Using a Graphic Rating Scale, this pilot study measured an 'overall' level of PI repeated about every 2 h over 1 day and compared it with maximal PI scores reported previously. Patients were categorized into severity groups according to the overall Graphic Rating Scale score at initial assessment (T0). Eight men and six women (mean age 53.1; range 28-75) participated. Comparison of the overall PI scores and their changes over time with the maximal PI scores reported previously showed loss of patients in the severe group and less pronounced PI changes over time. Rating scales used in spinal cord injury services should measure maximal pain experienced 'right now' to eliminate potential averaging out of pain over time, which might allow physicians to assist patients in understanding their pain and begin their adjustment.

Pain management following new and long-standing spinal cord injury: a pilot study of changes in pain intensity experienced during the day.

The aim of the study was to examine variations in pain intensity during the day experienced by patients with spinal cord injury. Fourteen consecutive patients had clinical and demographic data recorded. Pain intensity was recorded using a Graphic Rating Scale (GRS) at 2-3-h intervals. Patients were grouped according to maximum GRS into mild and severe groups at assessment (T0). Changes of one-third in GRS were deemed clinically significant. Eight men and six women (mean age 53.1; SD 16.5; range 28-75) were studied. Seven patients with mild pain tended to deteriorate and those with severe pain to improve. Eight patients demonstrated clinically significant changes. These findings suggest inadequate pain control early morning for one group and increasing pain during the day for another. Use of such simple scores over time would enhance pain rehabilitation for all spinal cord injury patients. Usual GRS reporting may mask clinically significant, treatable, changes in pain.

Attitudes of patients toward adoption of 3D technology in pain assessment: qualitative perspective.

BACKGROUND: Past research has revealed that insufficient pain assessment could, and often, has negative implications on the provision of quality health care. While current available clinical approaches have proven to be valid interventions, they are expensive and can often fail in providing efficient pain measurements. The increase in the prevalence of pain calls for more intuitive pain assessment solutions. Computerized alternatives have already been proposed both in the literature and in commerce, but may lack essential qualities such as accuracy of the collected clinical information and effective patient-clinician interaction. In response to this concern, 3-dimensional (3D) technology could become the innovative intervention needed to support and improve the pain assessment process. OBJECTIVE: The purpose of this analysis was to describe qualitative findings from a study which was designed to explore patients' perceptions of adopting 3D technology in the assessment of their pain experience related to important themes that might positively or negatively influence the quality of the pain assessment process. METHODS: The perceptions of 60 individuals with some form of pain in the area of Greater London were collected through semi-structured interviews. Of the 60 respondents, 24 (43%) produced usable responses and were analyzed for content using principles of the grounded theory approach and thematic analysis, in order to gain insight into the participants' beliefs and attitudes towards adopting 3D technology in pain assessment. RESULTS: The analysis identified 4 high-level core themes that were representative of the participants' responses. These themes indicated that most respondents valued "the potential of 3D technology to facilitate better assessment of pain" as the most useful outcome of adopting a 3D approach. Respondents also expressed their opinions on the usability of the 3D approach, with no important concerns reported about its perceived ease of use. Our findings finally, showed that respondents appreciated the perceived clinical utility of the proposed approach, which could further have an influence on their intention to use it. CONCLUSIONS: These findings highlighted factors that are seen as essential for improving the assessment of pain, and demonstrated the need for a strong focus on patient-clinician communication. The participants of this analysis believed that the introduction of 3D technology in the process might be a useful mechanism for such a positive health care outcome. The study's findings could also be used to make recommendations concerning the potential for inclusion of 3D technology in current clinical pain tools for the purpose of improving the quality of health care.

An interactive 3-D application for pain management: Results from a pilot study in spinal cord injury rehabilitation.

Research on pain following spinal cord injury (SCI) has revealed that patients not only experience several types of pain that could prove to be challenging to address, but also that each individual can interpret such pain in different subjective ways. In this paper we introduce a 3-D system for facilitating the efficient management of pain, and thus, supporting clinicians in overcoming the aforementioned challenges. This system was evaluated by a cohort of 15 SCI patients in a pilot study that took place between July and October 2010. Participants reported their experiences of using the 3-D system in an adapted version of the System Usability Scale (SUS) questionnaire. Statistically significant results were obtained with regards to the usability and efficiency of the 3-D system, with the majority of the patients finding it particularly useful to report their pain. Our findings suggest that the 3-D system can be an efficient tool in the efforts to better manage the pain experience of SCI patients.

Evaluating the usability of a virtual reality-based Android application in managing the pain experience of wheelchair users.

Pain constitutes an important medical concern that can have severe implications to a wheelchair user's quality of life. Results from studies indicate that pain is a common problem in this group of individuals, having a reported frequency of always (12%) and everyday (33%). This incidence signifies the need for more applicable and effective pain management clinical tools. As a result, in this paper we present an Android application (PainDroid) that has been enhanced with Virtual Reality (VR) technology for the purpose of improving the management of pain. Our evaluation with a group of wheelchair users revealed that PainDroid demonstrated high usability among this population, and is foreseen that it can make an important contribution in research on the assessment and management of pain.

3-D pain drawings and seating pressure maps: relationships and challenges.

Mobility impaired people constitute a significant portion of the adult population, which often experience back pain at some point during their lifetime. Such pain is usually characterized by severe implications reflected on both their personal lives, as well as on a country's health and economic systems. The traditional 2-D representations of the human body often used can be limited in their ability to efficiently visualize such pain for diagnosis purposes. Yet, patients have been shown to prefer such drawings. However, considering that pain is a feeling or emotion that is subjective in nature, the pain drawings could be consequently regarded as a subjective means of communicating such pain. As a result, the study described in this paper proposes an alternative, which encompasses a 3-D pain visualization solution, developed in a previous work of ours. This alternative is complemented with the upcoming technique of pressure mapping for more objectivity in the pain data collection. The results of this study have shown that the proposed approach is a promising solution for the purpose intended, and it could generally prove to be a significant complementary method in the area of medical practice for the mobility impaired community.

A pilot study to examine the relationship of 3D pain drawings with objective measures in mobility impaired people suffering from low back-pain.

Over the years, an increasing number of the adult population suffers from some form of back pain during their lifetime, something that consecutively has a very important impact on a country's health, as well as economic systems. It is beyond dispute though, that pain is a feeling or emotion that is subjective in nature. Thus, traditional methods of measuring pain are consequently considered to be subjective in their ability to efficiently gather and communicate such pain measurements. As a result, the work presented in this paper attempts to address the aforementioned limitation by presenting a theoretical framework, in which back pain measurements are taken, and the hypothetical association with objective measures, performed with the upcoming technique of pressure mapping, are indicated. A pilot study on wheelchair users to examine our proposed framework was conducted, with results of this pilot study showing that it is a promising solution for the purpose intended, and that it could generally prove to be a significant complementary method for the back pain community.