A Comprehensive Review of Telehealth for Pain Management: Where We Are and The Way Ahead

Abstract

Pain is generally undertreated in the United States, owing to a number of barriers including geographic distance from specialty treatment providers; functional disability that limits mobility; treatment-related stigma; economic limitations; and educational barriers. Pain undertreatment exacerbates pain chronicity and emotional disruption that can significantly erode a pain patient's quality of life, and there is widespread agreement that pain care must evolve to address this significant problem. The growing field of telehealth (defined for the purposes of this paper as technology that allows for distance interaction between providers and/or patients) offers a novel opportunity to expand pain assessment, consultation, and treatment services beyond the walls of the specialty pain clinic, but there is limited availability of resources describing how to best use this technology to improve access to care. A recent literature review (September 2011) using universally endorsed MeSH search criteria revealed only 32 MEDLINE references focusing on telehealth for pain. This is surprising in light of the very large number of references covering telehealth (14,164 references) and pain (104,564 references), respectively. Of the studies available, there are very few randomized trials of telehealth pain care and only one general overview of e-health and chronic pain, which dedicates just a few paragraphs to telehealth. This manuscript represents one of the first comprehensive reviews of the current state of telehealth and pain management research and practice. The goals are to provide a rationale for the potential benefit of telehealth-based pain management services; describe the various applications of telehealth technology for pain management; orient the reader to cost models for telehealth; present examples of services in place; and offer recommendations for future research based on the current state of knowledge.

Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial study design and sample characteristics

“…Automated symptom monitoring is an important tool for enhancing the feasibility and efficiency of telephone-based care management and the present study will contribute to this nascent body of research with telehealth applications for pain management [23]. A previous study in cancer patients with pain and/or depression showed high patient adherence and satisfaction with automated monitoring.…”

“…Automated data collection allows monitoring on a schedule convenient to the patient and subsequent formatting in a clinician-friendly trend report. There is even the potential for automated delivery of self-management and other simple behavioral interventions [23]. The stepped care algorithm for sequencing analgesic treatment linked to type of pain and current evidence (Table 2) coupled with a rational approach to opioid risk stratification and monitoring (Tables 3 and 4) are additional strategies that have great relevance for clinical practice.…”

“…Telemedicine is another strategy for enhancing the systems-based care of chronic conditions. However, a recent review of telehealth interventions for pain found few randomized trials [23].…”

Future Implications of eHealth Interventions for Chronic Pain Management in Underserved Populations

“…The hope is that the use of technology will allow for greater penetration of self-management education and skills training for individuals with chronic pain. Although some studies have shown promising outcomes for those receiving eHealth treatment interventions, multiple challenges remain in terms of reaching the underserved [26][27][28][29]. For example, many of the smartphone health applications currently in use did not involve healthcare professionals in the app development and did not conduct or report results of randomized controlled trials of efficacy prior to their release [30].…”

Effectiveness and cost-effectiveness of a guided and unguided internet-based Acceptance and Commitment Therapy for chronic pain: Study protocol for a three-armed randomised controlled trial.

“…Internet-based interventions might be a feasible means through which to increase uptake rates of chronic pain-specific interventions and, thus, help to improve health care for persons with chronic pain (Bender et al, 2011;Bennett & Glasgow, 2009;Eccleston, 2011;Keogh, 2013;Long & Palermo, 2009;McGeary et al, 2012;Rosser et al, 2011;Williams, 2011). To date, there is a growing evidence base for the effectiveness of internet-based CBT interventions for the treatment of chronic pain, with a considerable number of different interventions trialled (Berman et al, 2009;Eccleston et al, 2014;Keogh et al, 2010;Macea et al, 2010;Velleman et al, 2010).…”