Background & Aims

Low back pain (LBP) is the leading global cause of disability and impacts older Veterans with increased frequency and severity. The lifetime prevalence of LBP is estimated at 80%. Concerns about the profound health system burdens associated with the large number of people experiencing LBP have persisted. Despite extensive studies documenting a strong evidence-base for non-pharmacological therapies for LBP, we and others have demonstrated that most medical school curricula do not include sufficient training in the management of pain and LBP is especially underrepresented in medical school training programs [1,2]. One strategy that has been proposed is to enhance direct-to-patient education. This raises the question: what is the best way to reach the largest number of patients? There is a need for improved technological solutions for management of LBP; mobile applications (Apps) have been proposed as a potential solution for the limitations of health systems and resources.

Methods

An interprofessional team was formed to evaluate evidence and transform the existing literature into a series of incremental steps that could support persons with LBP in engaging in self-directed behavior change to reduce pain and pain impacts. We incorporated approaches include focusing on incremental progress; emphasizing achievable behaviors; linking behaviors together, e.g. App checking together with planning together with checking off accomplished tasks; and rewards for attaining specific goals with acknowledgement of attained goals with status indicators prominently displayed on the log in page and a special ‘trophy wall’. Concepts that we integrated pro-actively included incorporation and coordination of activities previously demonstrated as effective in resource-intensive clinical settings, inclusion of new and established therapies with proven effectiveness, and translation of published meta-analysis results into patient-accessible language.

Results

Evolution of activities in the App –The App subject matter expert team met biweekly to monthly over a three-year period to develop and deliberate on the domains, subdomains, and activities of the App beginning with draft content prepared by the PI. Utilizing newer approaches to behavior change developing from the work of clinical psychologists instructing patients in CBT – we acknowledged the important role of reflective writing and list-making in supporting self-directed behavior change. In the deployed form, the App had a total of 6 domains, each with 6 sub-domains associated with specific therapies, each of which can be engaged with progressively through selection of activities of varying intensity. We included a Pain Flare Action Plan – recognizing that acute worsening of pain in those with chronic pain-associated conditions represents an important risk for analgesic over-reliance.

Conclusions

The target for this project was the creation of a working Pain App that was mobile, capable of producing a patient-directed pain self-management plan that was evidence-based, and multidimensional in a manner consistent with whole health principles and aligned with the conceptual frameworks typical of interprofessional chronic pain management programs. We demonstrate the construction of a multidimensional evidence-based pain self-management mobile planning platform that incorporates coordination of multiple non-pharmacological therapies for pain in a manner that is consistent with whole health, motivational interviewing, and public health models of positive behavior change. Limitations of this construct include the incorporation of multiple innovations simultaneously which is not typical of most scientific processes but is standard practice for technological innovation. We are testing this App for feasibility and plan efficacy testing.

References

1. Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Kantner S, Ferguson AJR. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Apr. Report No.: 20-EHC009. PMID: 32338846.

2. Mezei L, Murinson BB; Johns Hopkins Pain Curriculum Development Team. Pain education in North American medical schools. J Pain. 2011 Dec;12(12):1199-208. doi: 10.1016/j.jpain.2011.06.006. Epub 2011 Sep 25. PMID: 21945594.

Presenting Author

Beth Hogans

Poster Authors

Beth Hogans

M.S. (Biomath), M.D., Ph.D.

Johns Hopkins SOM/ VA Maryland

Lead Author

E-mail

Luis Buenaver

Ph.D.

Johns Hopkins School of Medicine

Lead Author

E-mail

Elizabeth Parker

R.D.

University of Maryland School of Medicine

Lead Author

E-mail

Chadsley Wessinger

R.D.

University of North Carolina

Lead Author

E-mail

Topics

  • Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science