Dr Hemakumar Devan

One in five Kiwis live with chronic or persistent pain. And with little capacity to increase pain services, technology could help many self-manage their symptoms.

The recommendation comes from new research out of the University of Otago, Wellington.

Dr Hemakumar Devan a Postdoctoral fellow at the University’s Centre for Health, Activity and Rehabilitation Research, says high quality websites and apps which are free and readily available via smartphones and computers have the potential to help those living with chronic pain conditions, such as migraines, back and neck pain and arthritis.

People living with chronic pain – defined as persistent or recurring pain present for more than three months – are commonly managed in primary care or referred to specialist pain clinics where they learn various techniques to self-manage their symptoms on a daily basis.

However, Dr Devan says there are many barriers to accessing specialised pain services in New Zealand, including long waiting lists and the need to physically access services, which can be difficult for those in pain.

“There is little capacity to increase services because of the lack of a specialist pain workforce. Technology could be a useful adjunct to educate and empower people and their whānau to manage pain and associated symptoms on a day-to-day basis.”

Specialist staff at pain clinics teach cognitive behavioural therapy based techniques designed to improve people’s ability to take control of their symptoms and engage in valuable activities despite pain, Dr Devan says.

“People with persistent pain treated using active self-management techniques like activity pacing, relaxation and mindfulness are more likely to adopt active approaches and to show reduced long-term pain-related disability.”

Both websites and apps could complement face-to-face care for people with persistent pain, he says.

Dr Devan is the author of two recently published research papers which evaluated the use of best practice self-management strategies in currently available pain management websites and smartphone apps.

He analysed 27 websites which offered strategies to manage pain, including pain education, activity pacing, thought and behavioural management, exercises, relaxation/breathing techniques, meditation/mindfulness and distraction techniques.

The websites were all developed outside New Zealand, and included sites from the UK, Canada, Australia and the US. He rated three: LivePlanBe; MyJointPain; and ACI Pain Management Network as the best at providing information on pain self-management skills.

Dr Devan says meditation and guided relaxation were the most frequently included self-management strategies in the 19 pain management apps he assessed. Self-monitoring of symptoms and self tailoring of strategies were frequently included, but few of the apps had features to help patients gain support from others or communicate with their doctors.

The three apps which met the most criteria for fostering self-management of pain were Curable; PainScale – Pain Diary and Coach; and SuperBetter.

While the research opens up the possibility of clinicians referring patients to websites and apps to complement their face-to-face care, Dr Devan warns clinicians should be aware of the limitations of this approach.

“Clinicians must be aware of limitations, such as limited evidence for clinical efficacy of these online resources as a stand-alone treatment and a lack of cultural tailoring of information for those of different ethnicities, age groups and impairments.”

“It would be helpful to find out what people living with chronic pain think about these resources, and the value of a New Zealand-specific website as an educational resource for people with persistent pain and their whānau.”


The research:

‘Do pain management websites foster self-management support for people with persistent pain? A scoping review’ is published in the international journal Patient Education and Counselling and is available here: https://doi.org/10.1016/j.pec.2019.04.009

‘Evaluation of Self-Management Support Functions in Apps for People with Persistent Pain: A Systematic Review’ is published in the international journal, JMIR mHealth and uHealth. The paper is open access, available here: https://mhealth.jmir.org/2019/2/e13080/

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