Chronic Pain Clinical Trial
Official title:
Pain Monitor: a Randomized Controlled Trial to Test the Efficacy of a Pain App in the Treatment of Chronic Pain
The present investigation aims at exploring the effect of including a pain app called Pain
Monitor for chronic pain patients' daily monitoring. Three conditions will be set:
1. usual treatment (waiting list)
2. usual treatment + app (without alarms)
3. usual treatment + app (with alarms)
Chronic pain is defined as one that lasts for at least three to six months, provided that
this time is greater than the normal healing period of an injury. This pathology has become
an important public health problem due to its high prevalence. In particular, it is estimated
that it affects 20-30% of the adult population around the world. Medical interventions are
the first-line treatment in recent clinical practice guidelines. Unfortunately, the
effectiveness of medical interventions is only modest. Treatments significantly reduce pain
on average, but the effect tends to be small . In addition, the drugs are not effective for a
large percentage of patients.
What these and other research suggest is that focusing only on large sample studies and the
use of average change scores calls into question the usefulness of current patient-centered
treatments. As noted by Dr. Turk, when data are averaged, various pain syndromes, drugs,
surgical procedures, and studies in different countries are often included, which may mask
the efficacy results of different treatments with Different samples. Single case methodology
could be one of the ways to overcome these limitations. The single case investigation is a
type of experimental study that offers experimental control within a single case.
Some studies have already demonstrated the usefulness of these designs in chronic pain. In
fact, the benefits of using this methodology as opposed to large sample studies were
discussed recently during the 10th Congress of the European Pain Federation. These benefits
include the need for a reduced number of participants, the ability to follow clinical
evolution in real time and continuously, the amount of data provided, and applicability when
using a control group is impractical or unethical.
The investigators conducting the present investigation recently conducted a study at the Pain
Unit of the Vall d'Hebron Hospital to explore the effectiveness of current medical
treatments. According to previous investigations, the treatment effect was only small (d =
0.32) and only a percentage of the patients (18.1%) had a clinically significant reduction of
pain (ie a reduction greater than 30% ).
From these results and the literature reviewed, a single case design could be an alternative
method for research in the Pain Unit. However, the implementation of this type of methodology
can be very costly due to the continuous evaluation of the evolution of the patient. In this
sense, several studies have already shown that mobile applications (app) can effectively
control the evolution of a wide range of pathologies in health settings . In fact, a recent
controlled clinical study found that ecological records performed with mobile app had greater
reliability than paper-and-pencil records.
Rosser and Eccleston conducted a comprehensive review of existing apps for pain and the
conclusion was that there was little evidence to support the use of current apps.
Specifically, these authors showed that most apps did not specify whether their content was
validated, did not include psychological components and none had been applied in a clinical
study. In light of these results, Dr. Carlos Suso Ribera and Dr. Ribera Canudas contacted the
research team Labpsitec of Jaume I University, who were developing an application for pain
called "Pain Monitor". Dr. Carlos Suso Ribera and Dr. Ribera Canudas of the Pain Unit
collaborated with Dr. Azucena García Palacios and Dr. Diana Castilla López of the Universitat
Jaume I in the final development of the application of pain, Following the guidelines of
Rosser and Eccleston.
App content validity and usability was tested in a previous study at the pain unit of the
Vall d'Hebron Hospital (Suso-Ribera et al., in preparation). Thus, the study objective is to
test if the introduction of this tool in the day-to-day work of the pain unit improves pain
management of chronic pain patients. To do this, it is necessary to compare the evolution of
patients who follow the usual treatment at the pain unit (without app) with a group of
patients who do use the Pain Monitor app. In addition, the present study investigators have
created a new utility that allows alarms to be generated by healthcare professionals in the
presence of an undesired event, such as an adverse effect of the medication or a lack of
response to medical treatment. Before determining that both the use of the app and this new
utility (alarms) are beneficial for patient care, it is necessary to perform a clinical trial
comparing the 3 conditions mentioned above:
1. usual treatment (waiting list)
2. usual treatment + app (without alarms)
3. usual treatment + app (with alarms) Therefore, this is a clinical trial without drugs.
This is not an observational study since the physicians of patients in the app + alarms
condition will be asked to react to an alarm (i.e., if the patient has nausea for 3
consecutive days) by calling the patient and changing the treatment telematically, if
necessary, so that the patient can collect the prescription at his primary care center.
If the condition app with alarms results in a better treatment of chronic pain patients,
participants of the other two conditions will be offered the possibility to use the app with
alarms at the end of the study.
The study will be conducted at the Pain Unit of the Vall d'Hebron Hospital. All study
procedures have been approved by the ethical committee of the Vall d'Hebron Hospital.
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