Assessment of Attention to Pain Using Handheld Computer Diaries

Metastable Pain-Attention Dynamics during Incremental Exhaustive Exercise

Background: Pain attracts attention on the bodily regions. Attentional allocation toward pain results from the neural communication across the brain-wide network "connectome" which consists of pain-attention related circuits. Connectome is intrinsically dynamic and spontaneously fluctuating on multiple time-scales. The present study delineates the pain-attention dynamics during incremental cycling performed until volitional exhaustion and investigates the potential presence of nested metastable dynamics. Method: Fifteen young and physically active adults completed a progressive incremental cycling test and reported their discomfort and pain on a body map every 15 s. Results: The analyses revealed that the number of body locations with perceived pain and discomfort increased throughout five temporal windows reaching an average of 4.26 ± 0.59 locations per participant. A total of 37 different locations were reported and marked as painful for all participants throughout the cycling task. Significant differences in entropy were observed between all temporal windows except the fourth and fifth windows. Transient dynamics of bodily locations with perceived discomfort and pain were spanned by three principal components. The metastable dynamics of the body pain locations groupings over time were discerned by three time scales: (1) the time scale of shifts (15 s); (2) the time scale of metastable configurations (100 s), and (3) the observational time scale (1000 s). Conclusion: The results of this study indicate that body locations perceived as painful increase throughout the incremental cycling task following a switching metastable and nested dynamics. These findings support the view that human brain is intrinsically organized into active, mutually interacting complex and nested functional networks, and that subjective experiences inherent in pain perception depict identical dynamical principles to the neural tissue in the brain.

The Neural Code for Pain: From Single-Cell Electrophysiology to the Dynamic Pain Connectome

Pain occurs in time. In naturalistic settings, pain perception is sometimes stable but often varies in intensity and quality over the course of seconds, minutes, and days. A principal aim in classic electrophysiology studies of pain was to uncover a neural code based on the temporal patterns of single neuron firing. In contrast, modern neuroimaging studies have placed emphasis on uncovering the spatial pattern of brain activity (or “map”) that may reflect the pain experience. However, in the emerging field of connectomics, communication within and among brain networks is characterized as intrinsically dynamic on multiple time scales. In this review, we revisit the single-cell electrophysiological evidence for a nociceptive neural code and consider how those findings relate to recent advances in understanding systems-level dynamic processes that suggest the existence of a “dynamic pain connectome” as a spatiotemporal physiological signature of pain. We explore how spontaneous activity fluctuations in this dynamic system shape, and are shaped by, acute and chronic pain experiences and individual differences in those experiences. Highlighting the temporal dimension of pain, we aim to move pain theory beyond the concept of a static neurosignature and toward an ethologically relevant account of naturalistic dynamics.

Developments in the use of e-health for chronic pain management

SUMMARY Recognition that changes are required in how chronic conditions are managed, combined with advances in technology, has led to the emergence of e-health as a possible solution. This selective review seeks to illustrate some of the ways in which e-health has been applied to chronic pain. Examples of technology use are provided within the areas of information provision, assessment and monitoring, and remote therapy, and the various strengths and weaknesses associated with each method are highlighted. One of the main concerns is that, despite enthusiastic promises, evidence of e-health for pain management is often based on small numbers and few randomized controlled trials. However, the situation is improving, especially within the field of internet-based interventions where the number of higher quality trials is increasing, and results to date are encouraging. A sense of cautious optimism seems reasonable when considering the potential of e-health for the management of chronic pain.

Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives

OBJECTIVE

We sought to identify primary care providers' interest in, as well as perceived barriers and facilitators to, using novel telemedicine technologies (e.g., smartphones) for managing chronic non-cancer pain (CNCP) in older adults.

DESIGN

Six focus groups were conducted with 25 primary care providers.

SETTING

Two academically affiliated primary care practices serving older adults with CNCP in New York City.

METHODS

The investigators used content analysis to analyze transcribed focus group data and identify specific themes.

RESULTS

While most providers reported limited use of telemedicine, they expressed substantial interest in trying devices such as smartphones in the management of older patients with CNCP. Perceived barriers to implementation of telemedicine tools included information overload, lack of mobile device usability among patients and clinicians, liability issues, and cost. To overcome these barriers, participants suggested implementing electronic or human-based pre-analysis of data (e.g., a computer or a person that triages patient data), creating a low-cost and user-friendly mobile device design, and targeting appropriate user populations.

CONCLUSIONS

Primary care providers are interested in applying telemedicine when caring for older adults with CNCP. Although they perceived multiple barriers to device implementation, they offered innovative solutions to address these barriers. Providers felt that novel telemedicine technologies may improve the management of CNCP but wanted evidence that the devices were both cost- and time-efficient, and led to improved patient outcomes before adopting their use in practice.

Older adults are mobile too!Identifying the barriers and facilitators to older adults' use of mHealth for pain management

Background

Mobile health (mHealth) is a rapidly emerging field with the potential to assist older adults in the management of chronic pain (CP) through enhanced communication with providers, monitoring treatment-related side effects and pain levels, and increased access to pain care resources. Little is currently known, however, about older adults’ attitudes and perceptions of mHealth or perceived barriers and facilitators to using mHealth tools to improve pain management.

Methods

We conducted six focus groups comprised of 41 diverse older adults (≥60 years of age) with CP. Participants were recruited from one primary care practice and two multiservice senior community day-visit centers located in New York City that serve older adults in their surrounding neighborhoods. Focus group discussions were recorded and transcribed, and transcriptions were analyzed using direct content analysis to identify and quantify themes.

Results

Focus group discussions generated 38 individual themes pertaining to the use of mHealth to help manage pain and pain medications. Participants had low prior use of mHealth (5% of participants), but the vast majority (85%) were highly willing to try the devices. Participants reported that mHealth devices might help them reach their healthcare provider more expeditiously (27%), as well as help to monitor for falls and other adverse events in the home (15%). Barriers to device use included concerns about the cost (42%) and a lack of familiarity with the technology (32%). Facilitators to device use included training prior to device use (61%) and tailoring devices to the functional needs of older adults (34%).

Conclusions

This study suggests that older adults with CP are interested and willing to use mHealth to assist in the management of pain. Participants in our study reported important barriers that medical professionals, researchers, and mHealth developers should address to help facilitate the development and evaluation of age-appropriate, and function-appropriate, mHealth devices for older persons with CP.