Technology to ease the pain—with the patient at the controls

Despite all of the advances of modern medicine, pain is still one of our greatest challenges, particularly given that many of the more powerful medications are habit forming. But there is another conundrum, which is that pain is determined by self-reporting. There is really no test for it; instead, clinicians rely on patients to report based on a simple 1 to 10 scale or, as in the case with the short-form McGill Pain Questionnaire, by using verbal descriptors.Things are further complicated when there is no evident source for the pain. If a clinician can’t find the cause—in other words, if the patient seems to be otherwise healthy—there is a risk that the patient will not be believed, and be written off as a hypochondriac. This can happen with hard-to-diagnose illnesses such as fibromyalgia, back pain, and migraines. But there is some good news on this front: the Toronto General Hospital’s Transitional Pain Service (TPS) is embarking on an 18-month demonstration project for a mobile application called Manage My Pain.“The challenge has always been to get pain validated or understood,” says Tahir Janmohamed, founder and CEO of ManagingLife, the software company that developed the application. “There is no standard test for pain, and many people don’t have the language to express what they’re feeling. That’s why our first approach was not to talk to physicians or researchers, but to approach the people with pain.”Once discharged from the hospital, patients participating in the pilot will actively record their pain, which can then be remotely monitored by the TPS’s multidisciplinary team.”The application has eight sections to describe a pain episode,” says Janmohamed. “We’ve separated the concept of capturing pain with how it is reported to health practitioners, because they want to see a different format. We’ve spent a lot of time making sure our reports are doctor friendly – these are one-page summaries, with the physicians then able to get more granular if they’d like.”The Toronto General seems like a good fit for the application. As part of the University Health Network, the hospital performs more than 25,000 surgical operations annually. The medical director of the Transitional Pain Service, Dr. Hance Clarke, has noted that while hospitals do a decent job dealing with pain, the support doesn’t last beyond the hospital stay. With the Manage My Pain applications, the potential is there to extend support into the home.“This is an application that requires daily or weekly engagement,” says Janmohamed. “Everything falls apart if people don’t use it. But when patients do use it, we see results: over 85% who use the application for three months or more say they can better communicate with their doctors.”For his part, Dr. Clarke at Toronto General says that about half of all patients are now sent home with a prescription for an opioid drug, with approximately 30% of surgical patients at risk of developing chronic pain. Clearly, finding a way to help patients get more control over their pain management, and to collaborate with caregivers, is a step in the right direction.“We are now working closely with the Toronto General Hospital to take this to the next level,” says Janmohamed. “That would involve an online portal, and calling out key indicators that patients need to make their lives easier.”The Manage My Pain application is not new. It was developed in 2011 as a beta version, and launched in 2012. Since then, there have been 50 software updates to enhance functionality. This is a cloud-based application, with ManagingLife using Amazon Web Services (AWS) as the host. That might pose a problem, as the data is in the United States, but Janmohamed is confident there won’t be any issues.“We are presenting this as users’ data,” he says. “They own it. They are the providing consent. This is not the hospital’s data.”The advantage with the AWS approach is that ManagingLife can deliver the application to virtually anywhere in the world, and scale as needed. This is a big market, after all: it is estimated that chronic pain develops in 5% to 10% of patients within a year of major surgery.Right now, the application is available on Android and BlackBerry, with an iOS version expected in early 2016. The plan is to license the application to hospitals and insurance companies, and to demonstrate the value it provides to those patients experiencing pain.“There is a natural incentive for insurers and employee benefits programs to pay for this,” says Janmohamed. “Because, ultimately, people want to get back to work faster, and to use less medication.”Tim Wilson is principal of T Wilson Associates. Follow him on Twitter: @TimothyEWilson

Technology to ease the pain—with the patient at the controls

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