Digital Health Tools Offer Hope For Chronic Pain

The COVID-19 pandemic—and the healthcare access barriers that accompanied it—accelerated interest in digital tools. At the same time, the country's ongoing struggle with the opioid epidemic underscored the critical need for new therapies and approaches to addressing chronic pain, a condition that affects more than 50 million US adults.

Those developments are set amid a broader landscape of shifting federal and state guidelines, with an increasing emphasis on the value of alternative therapies for managing chronic pain. In fact, the Center for Disease Control and Prevention's recent clinical practice guidelines recommend that clinicians ensure patients are aware of alternatives to opioids before starting that therapy.

Against that backdrop, digital health tools are proliferating. From software and sensors to mobile apps and virtual reality (VR), new research offers optimism about technology's tremendous potential in treating chronic pain.

"Digital health innovations hold much promise in providing complementary solutions to traditional medical interventions and may reduce cost and speed up recovery or adaptation," wrote the authors of a 2023 article in Frontiers in Pain Research. "There is a growing evidence base for the use of digital health in pain assessment, diagnosis, and management."

Virtual worlds can alter real-life pain perception

Imagine putting on a VR headset and breathing deeply while focusing on a tree. As you exhale, the tree's form shifts in response. Those diaphragmatic breathing techniques could be used long after the headset is removed as a technique to cope with chronic pain.

Another example to consider: the VR game “SnowWorld," which transports burn survivors to a soothing, icy environment where they can find relief in throwing virtual snowballs at penguins.

Increasingly, scientists are looking at the role of immersive experiences and a multitude of other digital health tools as a way of helping people address chronic pain. The need for these new options is critical and urgent.

Chronic pain widespread and growing

About 21% of US adults experience chronic pain, which is defined as pain that someone experiences on most days or every day during the past 3 months, according to 2023-published findings from the National Institutes of Health. Meanwhile, 8% of adults experience high-impact chronic pain, or pain that limits life or work activities on most days or every day during the past 3 months. The condition is persistent: two-thirds of people with chronic pain still suffer from it a year later.

New cases of chronic pain occur more often among US adults than new cases of diabetes, depression, and high blood pressure, each recognized as a significant threat to the health of people in the US.

In addition, comorbidities are commonly associated with chronic pain, including depression, anxiety, sleep problems, and fatigue—conditions that can negatively impact someone's quality of life.

"Those findings on chronic pain prevalence demonstrate why it's so important to expand multimodal, multidisciplinary interventions to address the pain and improve outcomes," said Richard Nahin, PhD, the study's lead author, in a press release discussing the findings.

Digital health interventions address barriers

These new interventions could also ease some of the healthcare barriers chronic pain patients frequently face. A limited supply of providers trained in chronic pain intervention coupled with increasing demand for these services has led to access challenges. Other care barriers include work and/or childcare demands, functional disability, financial cost, and geographic distances, describes a fact sheet from the International Association for the Study of Pain (IASP).

The COVID-19 pandemic fortified barriers in all of those areas, prompting innovation in chronic pain care delivery, the IASP says. Along with improving access, digital tools offer other notable advantages, such as the ability to access additional services outside of a clinic setting at asynchronous times. In addition, cost tends to be lower than traditional healthcare service.

Access barriers are improving as technology becomes more portable, easy, and affordable, such as VR headsets that can be sent to a patient's home and self-administered.

What kinds of digital tools exist for chronic pain?

There are numerous digital tools designed to assess and treat chronic pain as well as improve patient access and engagement, according to an article published in Frontiers in Public Health:

• Immersive Technology: There are some “promising results" in the use of VR-based therapy for people with chronic pain. For example, researchers have examined VR as a therapy for fear of movement in veterans with chronic pain. In 2021, the U.S. Food & Drug Administration authorized the marketing of a prescription-use virtual reality system for chronic pain reduction.
• Artificial Intelligence: Increasingly, AI is being used throughout healthcare, including diagnosis and therapy management. With chronic pain, machine learning algorithms have used data on respiration rates, oxygen levels, pulse rate, body temperature, blood pressure, and other measures to gauge subjective pain levels and changes in pain.
• Remote Patient Monitoring: Digital tools, such as smartphone apps, sensors, and wearables, can help providers collect and track pain-related data in between appointments—an important step in gauging whether a patient's quality of life is improving.
• Digital Therapy: This refers to devices and methods that can provide frequent counseling to patients to improve their behaviors and lifestyle habits. Most digital therapies use a cognitive behavioral approach.
• Virtual Patient Engagement: Digital communication channels can provide a robust tool for patient involvement in their care, regardless of location.

Evaluating digital tool efficacy

Most published research on the use of digital tools has found a small to medium effect on pain outcomes, according to the IASP brief. Digital platforms that incorporate therapists or coaches, either in a synchronous or asynchronous way, has shown “the most consistent positive impact" on engagement and outcomes, the group notes.

Findings published in July in npj Digital Medicine accentuate the tremendous potential of new approaches to address chronic pain. In this study, researchers investigated how a digital care program compared to conventional physical therapy for people with low back pain. They found that a remote digital intervention can promote the same levels of recovery as evidence-based in-person therapy.

That effectiveness of digital care is especially significant as these tools could reduce longstanding access barriers, authors wrote: “The digital format favors the democratization of healthcare access by overcoming geographical barriers (reaching rural or underserved areas), decreasing treatment start waiting time, and promoting patient engagement while ensuring the quality of care and potentially lowering costs."

Digital tools could reduce opioid use

As interest in using digital tools for chronic pain grows, more research is necessary to determine if and how these digital tools can be used to reduce the use of opioid pain medications. Clinical evidence for digital interventions in pain management is still limited, point out the authors of a 2022 mini review on the topic published in Frontiers of Digital Health. That review suggested that both VR and mobile apps could be used as "adjunct digital therapies" in conjunction with opioid-based pain medications.

That approach seems to be playing out on the ground, with health organizations using digital health technologies as complements to available substance use disorder treatments rather than substitutes, researchers reported in a 2023 JAMA Network Open study.

Indeed, the value of these tools might lie in their ability to work alongside therapies such as opioids and reduce the dosage, write authors of an article published in Frontiers of Pain Research. Those authors also questioned whether “non-pharmacologic therapies will ever achieve the level of effectiveness needed to justify their use as a sole treatment for moderate to severe chronic non-cancer pain.

Entering VR world reduced opioid need

A frequently-cited study demonstrated how digital approaches could reduce opioid usage. Researchers looked at the use of immersive VR during painful wound care procedures and published their findings in the Journal of Burn Care & Research. Using a VR tool reduced the amount of opioid medications administered during a wound care procedure by 39%, compared to patients who did not use the immersive technology.

VR's ability to reduce pain might lie in the “strong psychological component" of pain perception, explains an article from the University of Washington, where SnowWorld was developed in collaboration with Harborview Burn Center. Entering a new world draws attention away from pain signal processing.

Health tech start-ups address chronic pain

Given the prevalence of chronic pain among US adults, it may not be surprising that companies and healthcare systems alike are paying attention to these new treatment options.

Increasingly, startups are looking at helping people address chronic pain with digital tools, such as phone apps, STAT reported. The pandemic's resulting care delays, especially for people without acute conditions, coupled with a reluctance to use opioid painkillers, may be fueling the growing industry. The tools' emphasis on both physical and psychological therapies highlights an increased recognition of that “effective pain treatment is multimodal," the article notes.

Growth and interest in digital musculoskeletal (MSK) therapies has also soared in recent years, with companies such as Kaia Health and Sword Health offering digital solutions for MSK pain. These care models utilize a mix of digital health tools such as applications on smartphones and tablets/computers, telerehabilitation, and remote monitoring to treat conditions impacting people's bones, joints, tissues, and muscles.

Hospital, health system leaders paying attention

In a Becker's Health IT article exploring the top digital healthcare trends of 2023 so far, some health system digital leaders pointed to digital therapeutics, software or device-based interventions that could manage and treat conditions like chronic pain.

Health systems are already incorporating digital health solutions into on-the-ground strategies to manage and address chronic pain. Take, for example, The MetroHealth System in Cleveland, which earlier this year launched a partnership to develop and deploy a comprehensive pain management program.

The system is working with Fern Health, a company that specializes in digital management of chronic pain, to develop digital tools to complement traditional pain management. They're working on logistics, such as scaling the programs in a clinical setting, integrating the programs with electronic health records and clinical workflow, and figuring out reimbursement pathways, the company said in a 2023 news release.

As interest grows, keep health equity in mind

Amid the growing interest and use of digital health tools in pain assessment, diagnosis, and management, it's vital to keep health equity at the forefront. Creating a framework to evaluate these emerging tools can help support equitable access, note the authors of a recent article in Frontiers Pain Research.

“The challenge is not only to develop new technologies and solutions, but to do this within a framework that supports health equity, scalability, socio-cultural consideration, and evidence-based science," they write.

Along with ensuring solutions are evidence-based and respect patient privacy, it's also important to consider whether they are affordable, scalable, and able to be integrated into the healthcare system.

RTI can help you evaluate digital options

As new digital health tools emerge to address chronic pain, RTI can help you navigate evidence and efficacy while promoting equitable access. We can counsel app developers that design and develop digital health solutions that providers need to improve access and care for all people.