Digital Pain Mapping and Tracking in Patients With Chronic Pain: Longitudinal Study

Abstract

Background Digital pain mapping allows for remote and ecological momentary assessment in patients over multiple time points spanning days to months. Frequent ecological assessments may reveal tendencies and fluctuations more clearly and provide insights into the trajectory of a patient’s pain. Objective The primary aim of this study is to remotely map and track the intensity and distribution of pain and discomfort (eg, burning, aching, and tingling) in patients with nonmalignant spinal referred pain over 12 weeks using a web-based app for digital pain mapping. The secondary aim is to explore the barriers of use by determining the differences in clinical and user characteristics between patients with good (regular users) and poor (nonregular users) reporting compliance. Methods Patients (N=91; n=53 women) with spinal referred pain were recruited using web-based and traditional in-house strategies. Patients were asked to submit weekly digital pain reports for 12 weeks. Each pain report consisted of digital pain drawings on a pseudo–three-dimensional body chart and pain intensity ratings. The pain drawings captured the distribution of pain and discomfort (pain quality descriptors) expressed as the total extent and location. Differences in weekly pain reports were explored using the total extent (pixels), current and usual pain intensity ratings, frequency of quality descriptor selection, and Jaccard similarity index. Validated e-questionnaires were completed at baseline to determine the patients’ characteristics (adapted Danish National Spine Register), disability (Oswestry Disability Index and Neck Disability Index), and pain catastrophizing (Pain Catastrophizing Scale) profiles. Barriers of use were assessed at 6 weeks using a health care–related usability and acceptance e-questionnaire and a self-developed technology-specific e-questionnaire to assess the accessibility and ease of access of the pain mapping app. Associations between total extent, pain intensity, disability, and catastrophizing were explored to further understand pain. Differences between regular and nonregular users were assessed to understand the pain mapping app reporting compliance. Results Fluctuations were identified in pain reports for total extent and pain intensity ratings (P<.001). However, quality descriptor selection (P=.99) and pain drawing (P=.49), compared using the Jaccard index, were similar over time. Interestingly, current pain intensity was greater than usual pain intensity (P<.001), suggesting that the timing of pain reporting coincided with a more intense pain experience than usual. Usability and acceptance were similar between regular and nonregular users. Regular users were younger (P<.001) and reported a larger total extent of pain than nonregular users (P<.001). Conclusions This is the first study to examine digital reports of pain intensity and distribution in patients with nonmalignant spinal referred pain remotely for a sustained period and barriers of use and compliance using a digital pain mapping app. Differences in age, pain distribution, and current pain intensity may influence reporting behavior and compliance.

User Engagement and Assessment of Treatment Effectiveness in Patients Using a Novel Digital mHealth App During Spinal Cord Stimulation Screening Trials

“…In accordance with previous reports that have shown that patients with chronic pain are strongly interested and eager to use a digital health-based mobile app, we found that a large percentage of patients undergoing an SCS trial, if offered, are willing to use such a tool [ 4 , 6 , 8 ]. Given the importance the trial phase can have on the decision to proceed with permanent implantation of an SCS device, this sizable rate of user participation demonstrates the potential viability of a mobile tracking app to improve the utility of an SCS trial.…”

“…More importantly, these contemporary tools have been demonstrated to help instill a greater level of assurance in patients, that their pain condition can be controlled. These devices can also promote improved self-monitoring of the multidimensional experience of chronic pain, and some concurrently allow health care providers enhanced connectivity to real time outcomes reported by those under their care [ 4 - 6 ]. The implementation and use of new digital methodologies in the context of health care is underpinned by what is now referred to as ecological momentary assessment (EMA), an approach constituted by the frequent sampling of study subjects’ behavior, outcomes, and experiences in real time within the real-world environments in which they live and participate [ 7 , 8 ].…”

Pain provocation tests and clinical entities in male football players with longstanding groin pain are associated with pain intensity and disability

“…In various pain conditions, an increased pain area is related to higher pain intensity and disability (Lluch Girbés et al, 2016;Boudreau et al, 2017;Galve Villa et al, 2020;Miró et al, 2014Miró et al, , 2017Barbero et al, 2017). Similarly, a larger area of groin pain based on pain drawings is positively associated with groin pain intensity, the number of clinical entities, and the presence of bilateral symptoms in athletes with longstanding groin pain (Serner et al, 2022).…”

Quantification of Patient-Reported Pain Locations

“…For example, it will make pain assessment more accurate and efficient to enhance easy tracking of patient response to treatment. This method can be applied to patients with acute 21 or chronic 22 pain longitudinally using any digital records at no cost and yet produce accurate results. Because of advantages in momentary assessment of pain, there may be no variability of pain location, but increasing BSA could indicate progression in the cause of pain and alert the nurse to take appropriate action to treat the cause of pain.…”

“…In previous studies, investigators examined the association between the number of pain locations with other pain variables (eg, pain intensity, duration, and quality), 23,24 negative disease outcomes such as disability, 18 and pain centralization. 7 Digital pain drawings are receiving increased attention 21,22 because of the aforementioned advantages to improve pain assessment and management. Pain distribution and location, however, have not been measured frequently due to multiple reasons.…”