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El-Tallawy SN, Pergolizzi JV, Vasiliu-Feltes I, Ahmed RS, LeQuang JK, Alzahrani T, Varrassi G, Awaleh FI, Alsubaie AT, Nagiub MS. Innovative Applications of Telemedicine and Other Digital Health Solutions in Pain Management: A Literature Review. Pain Ther 2024; 13:791-812. [PMID: 38869690 PMCID: PMC11255158 DOI: 10.1007/s40122-024-00620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
Since the COVID-19 pandemic, healthcare systems are facing extraordinary challenges. Our approaches to medicine have changed and created a whole new generation of people who have chronic pain. Various medical services were postponed. The pandemic significantly impacted the bio-psychosocial model of pain and the management of chronic pain. These new challenges affected millions of patients worldwide, with more burden on patients with chronic pain. Telemedicine and digital health rather than traditional office visits have become essential tools for communications, resulting in an unmatched surge in telehealth adoption. This new approach facilitated the remote treatment and follow-up of patients who have difficulty to access the healthcare services, particularly patients with chronic pain and those who were receiving regular controlled medications. An extensive computer search was conducted, during the period (from January 2014 to March 2024), and included literature from PubMed, Scopus, MEDLINE, and Google scholar. According to preset inclusion and exclusion criteria, a total of 38 articles have been included in this review article. This literature review focuses on the innovation of telemedicine and digital health in pain management, especially in the context of the challenges posed by the COVID-19 pandemic. The manuscript provides a comprehensive overview of telemedicine and digital communications, their evolution, and their significance in healthcare. It also emphasizes the benefits, challenges, limitations, and the ethical concerns of telemedicine in pain management after the COVID-19 pandemic. Furthermore, the document explores the different modes of the telecommunications and discusses the future directions of the digital health technology.
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Affiliation(s)
- Salah N El-Tallawy
- Anesthesia and Pain Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Anesthesia Department, Faculty of Medicine, Minia University & NCI, Cairo University, Cairo, Egypt.
| | | | | | - Rania S Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Tariq Alzahrani
- Anesthesia and Pain Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Fouad I Awaleh
- Anesthesia Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah T Alsubaie
- Anesthesia Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Bérubé M, Verret M, Bourque L, Côté C, Guénette L, Richard-Denis A, Ouellet S, Singer LN, Gauthier L, Gagnon MP, Gagnon MA, Martorella G. Educational needs and preferences of adult patients with acute pain: a mixed-methods systematic review. Pain 2024:00006396-990000000-00630. [PMID: 38888742 DOI: 10.1097/j.pain.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/28/2024] [Indexed: 06/20/2024]
Abstract
ABSTRACT Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
| | - Michael Verret
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurence Bourque
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Caroline Côté
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Andréane Richard-Denis
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, QC, Canada
| | - Simon Ouellet
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Lesley Norris Singer
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Lynn Gauthier
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
- Oncology Division, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Cancer Research Centre, Université Laval, Québec City, QC, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, Tallahassee, FL, United States
- Florida State University Brain Science and Symptom Management Center, Tallahassee, FL, United States
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El-Tallawy SN, Pergolizzi JV, Vasiliu-Feltes I, Ahmed RS, LeQuang JK, El-Tallawy HN, Varrassi G, Nagiub MS. Incorporation of "Artificial Intelligence" for Objective Pain Assessment: A Comprehensive Review. Pain Ther 2024; 13:293-317. [PMID: 38430433 PMCID: PMC11111436 DOI: 10.1007/s40122-024-00584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024] Open
Abstract
Pain is a significant health issue, and pain assessment is essential for proper diagnosis, follow-up, and effective management of pain. The conventional methods of pain assessment often suffer from subjectivity and variability. The main issue is to understand better how people experience pain. In recent years, artificial intelligence (AI) has been playing a growing role in improving clinical diagnosis and decision-making. The application of AI offers promising opportunities to improve the accuracy and efficiency of pain assessment. This review article provides an overview of the current state of AI in pain assessment and explores its potential for improving accuracy, efficiency, and personalized care. By examining the existing literature, research gaps, and future directions, this article aims to guide further advancements in the field of pain management. An online database search was conducted via multiple websites to identify the relevant articles. The inclusion criteria were English articles published between January 2014 and January 2024). Articles that were available as full text clinical trials, observational studies, review articles, systemic reviews, and meta-analyses were included in this review. The exclusion criteria were articles that were not in the English language, not available as free full text, those involving pediatric patients, case reports, and editorials. A total of (47) articles were included in this review. In conclusion, the application of AI in pain management could present promising solutions for pain assessment. AI can potentially increase the accuracy, precision, and efficiency of objective pain assessment.
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Affiliation(s)
- Salah N El-Tallawy
- Anesthesia and Pain Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
- Anesthesia and Pain Department, Faculty of Medicine, Minia University & NCI, Cairo University, Giza, Egypt.
| | | | - Ingrid Vasiliu-Feltes
- Science, Entrepreneurship and Investments Institute, University of Miami, Miami, USA
| | - Rania S Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Biskupiak Z, Ha VV, Rohaj A, Bulaj G. Digital Therapeutics for Improving Effectiveness of Pharmaceutical Drugs and Biological Products: Preclinical and Clinical Studies Supporting Development of Drug + Digital Combination Therapies for Chronic Diseases. J Clin Med 2024; 13:403. [PMID: 38256537 PMCID: PMC10816409 DOI: 10.3390/jcm13020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Limitations of pharmaceutical drugs and biologics for chronic diseases (e.g., medication non-adherence, adverse effects, toxicity, or inadequate efficacy) can be mitigated by mobile medical apps, known as digital therapeutics (DTx). Authorization of adjunct DTx by the US Food and Drug Administration and draft guidelines on "prescription drug use-related software" illustrate opportunities to create drug + digital combination therapies, ultimately leading towards drug-device combination products (DTx has a status of medical devices). Digital interventions (mobile, web-based, virtual reality, and video game applications) demonstrate clinically meaningful benefits for people living with Alzheimer's disease, dementia, rheumatoid arthritis, cancer, chronic pain, epilepsy, depression, and anxiety. In the respective animal disease models, preclinical studies on environmental enrichment and other non-pharmacological modalities (physical activity, social interactions, learning, and music) as surrogates for DTx "active ingredients" also show improved outcomes. In this narrative review, we discuss how drug + digital combination therapies can impact translational research, drug discovery and development, generic drug repurposing, and gene therapies. Market-driven incentives to create drug-device combination products are illustrated by Humira® (adalimumab) facing a "patent-cliff" competition with cheaper and more effective biosimilars seamlessly integrated with DTx. In conclusion, pharma and biotech companies, patients, and healthcare professionals will benefit from accelerating integration of digital interventions with pharmacotherapies.
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Affiliation(s)
- Zack Biskupiak
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Victor Vinh Ha
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Aarushi Rohaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84113, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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Blake H, Chaplin WJ, Wainwright E, Taylor G, McNamee P, McWilliams D, Abbott-Fleming V, Holmes J, Fecowycz A, Walsh DA, Walker-Bone K. The Web-Based Pain-at-Work Toolkit With Telephone Support for Employees With Chronic or Persistent Pain: Protocol for a Cluster Randomized Feasibility Trial. JMIR Res Protoc 2023; 12:e51474. [PMID: 37902814 PMCID: PMC10644198 DOI: 10.2196/51474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/19/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Chronic or persistent pain affects one's ability to work or be productive at work, generating high societal and economic burden. However, the provision of work-related advice and support for people with chronic pain is variable or lacking. The Pain-at-Work (PAW) Toolkit was cocreated with people who live with pain, health care professionals, and employers. It aims to increase knowledge about employee rights and how to access support for managing a painful chronic condition in the workplace and provides advice on lifestyle behaviors that facilitate the management of chronic pain. OBJECTIVE We aimed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing access to the PAW Toolkit and telephone support calls from an occupational therapist (PAW) with treatment as usual (ie, standard support from their employer). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, and safety of this digital workplace health intervention. We will assess the candidate primary and secondary outcomes' feasibility and test research processes for a definitive trial. METHODS This is an open-label, parallel 2-arm pragmatic feasibility cluster randomized controlled trial with exploratory health economics analysis and a nested qualitative interview study. We aim to recruit 120 participants from at least 8 workplace clusters (any type, >10 employees) in England. The recruitment of workplaces occurs via personal approach, and the recruitment of individual participants is web based. Eligible participants are vocationally active adults aged ≥18 years with internet access and self-reporting chronic pain interfering with their ability to undertake or enjoy productive work. A restricted 1:1 cluster-level randomization is used to allocate employment settings to PAW or treatment as usual; participants are unblinded to group allocation. Following site- and individual-level consent, participants complete a web-based baseline survey (time 0), including measures of work capacity, health and well-being, and health care resource use. Follow-up is performed at 3 months (time 1) and 6 months (time 2). Feasibility outcomes relate to recruitment; intervention fidelity (eg, delivery, reach, uptake, and engagement); retention; and follow-up. Qualitative evaluation (time 2) is mapped to the Capability, Opportunity, Motivation-Behavior model and will explore intervention acceptability to employees and employers, along with individual and contextual factors influencing the delivery and uptake of the intervention. RESULTS Ethics approval was obtained in March 2023. Trial recruitment began in June 2023. CONCLUSIONS The PAW Toolkit is the first evidence-based digital health intervention aimed at supporting the self-management of chronic or persistent pain at work. This study will inform the design of a definitive trial, including sample size estimation, approaches to cluster site identification, primary and secondary outcomes' selection, and the final health economic model. Findings will inform approaches for the future delivery of this digital health intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT05838677; https://clinicaltrials.gov/study/NCT05838677. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51474.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Wendy J Chaplin
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Daniel McWilliams
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Jain Holmes
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Aaron Fecowycz
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David Andrew Walsh
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Karen Walker-Bone
- School of Public Health and Preventive Medicine, Monash University, Australia, United Kingdom
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Ahmad M, Bani Mohammad E, Tayyem E, Al Gamal E, Atout M. Pain and anxiety in patients with breast cancer treated with morphine versus tramal with virtual reality. Health Care Women Int 2023; 45:782-795. [PMID: 37703384 DOI: 10.1080/07399332.2023.2257627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
The treatment of pain and anxiety in cancer patients includes both pharmaceutical and non-pharmacological approaches. The researchers of this study aimed to compare the effectiveness of morphine versus Tramal with virtual reality therapy (VR) in reducing pain and anxiety in female patients with breast cancer. The sample was composed of 80 women with breast cancer who where treated at a specialized cancer center in Jordan. A quasi-experimental design was used in the study intervention. When used with VR, the tramal analgesics did not differe significactly from the effect of morphine in reducing the pain and anxiety. However, both groups had a significant drop in the level of pain and anxiety. When combined with VR, the use of weak opioids such as Tramal will have nearly the same effect as strong opioids such as Morphine in reducing pain and anxiety in breast cancer patients.
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Affiliation(s)
- Muayyad Ahmad
- Clinical Nursing Department School of Nursing, The University of Jordan, Amman, Jordan
| | | | - Eman Tayyem
- Nursing Department, Arab American University of Palestine Jenin, Jenin, State of Palestine
| | - Ekhlas Al Gamal
- Psychiatric and Mental Health Nursing Department of Community Health Nursing School of Nursing, The University of Jordan, Amman, Jordan
| | - Maha Atout
- Faculty of Nursing, Philadelphia University, Jarash, Jordan
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Ribba B, Peck R, Hutchinson L, Bousnina I, Motti D. Digital Therapeutics as a New Therapeutic Modality: A Review from the Perspective of Clinical Pharmacology. Clin Pharmacol Ther 2023; 114:578-590. [PMID: 37392464 DOI: 10.1002/cpt.2989] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023]
Abstract
The promise of transforming digital technologies into treatments is what drives the development of digital therapeutics (DTx), generally known as software applications embedded within accessible technologies-such as smartphones-to treat, manage, or prevent a pathological condition. Whereas DTx solutions that successfully demonstrate effectiveness and safety could drastically improve the life of patients in multiple therapeutic areas, there is a general consensus that generating therapeutic evidence for DTx presents challenges and open questions. We believe there are three main areas where the application of clinical pharmacology principles from the drug development field could benefit DTx development: the characterization of the mechanism of action, the optimization of the intervention, and, finally, its dosing. We reviewed DTx studies to explore how the field is approaching these topics and to better characterize the challenges associated with them. This leads us to emphasize the role that the application of clinical pharmacology principles could play in the development of DTx and to advocate for a development approach that merges such principles from development of traditional therapeutics with important considerations from the highly attractive and fast-paced world of digital solutions.
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Affiliation(s)
- Benjamin Ribba
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Peck
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Lucy Hutchinson
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Imein Bousnina
- Genentech, A Member of the Roche Group, Washington, DC, USA
| | - Dario Motti
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Hadjiat Y, Arendt-Nielsen L. Digital health in pain assessment, diagnosis, and management: Overview and perspectives. FRONTIERS IN PAIN RESEARCH 2023; 4:1097379. [PMID: 37139342 PMCID: PMC10149799 DOI: 10.3389/fpain.2023.1097379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Managing pain is essential for social, psychological, physical, and economic reasons. It is also a human right with a growing incidence of untreated and under-treated pain globally. Barriers to diagnosing, assessing, treating, and managing pain are complicated, subjective, and driven by patient, healthcare provider, payer, policy, and regulatory challenges. In addition, conventional treatment methods pose their own challenges including the subjectivity of assessment, lack of therapeutic innovation over the last decade, opioid use disorder and financial access to treatment. Digital health innovations hold much promise in providing complementary solutions to traditional medical interventions and may reduce cost and speed up recovery or adaptation. There is a growing evidence base for the use of digital health in pain assessment, diagnosis, and management. 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. The extensive limits to physical personal interaction during the Covid-19 pandemic 2020/21 has proven the possible role of digital health in the field of pain medicine. This paper provides an overview of the use of digital health in pain management and argues for the use of a systemic framework in evaluating the efficacy of digital health solutions.
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Affiliation(s)
- Yacine Hadjiat
- Paris Saclay University, National Institute of Health and Medical Research, U987, Inserm, Paris, France
- Correspondence: Yacine Hadjiat
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg E, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg C, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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