Background & Aims

Chronic low back pain (CLBP) is a major global health problem [1]. However, today’s standard of care or the overprescription of opioids often only allows for limited improvement or strong side effects in patients [2]. International pain societies and guidelines opt for a bio-psycho-social consideration and multimodal, interdisciplinary care in assessing and managing patients suffering from CLBP. This includes the integration of effective non-drug solutions such as percutaneous auricular Vagus Nerve Stimulation (pVNS) [3,4]. Care can be further improved by implementing digital treatment management supporting coordination between therapists, individualized care plans, effective documentation, patient engagement, education, and remote monitoring [5].

Aim of SENECA is to implement technological solutions to optimize multimodal CLBP treatment and improve long-term outcomes by integrating pVNS and an online therapy management system including a dedicated patient smartphone app.

Methods

In SENECA, patients and pain specialists will be actively involved in the development of a pain management platform, including a physician dashboard for therapy management and documentation as well as a patient smartphone app. In addition to the current standard of care, pVNS (VIVO®, AURIMOD GmbH, Austria) will be integrated as therapeutic modality in a 4-week outpatient multimodal CLBP therapy program at Klinikum Klagenfurt, Austria [6]. Therapists should be supported by digital infrastructure and technical solutions to optimize patient care. Requirements for such pain management system will be derived within a user-centered design and co-creation process. At the same time, ethical and data protection aspects will be thoroughly considered. The pain management platform will be built based on AIT’s established Keep-In-Touch Telehealth Platform [7]. Feasibility of the developed solution will be tested in a pilot study in CLBP patients, eligible for the multimodal pain management program.

Results

The project aims to provide solutions for a more effective multimodal CLBP treatment program and improved patient outcomes. It will implement: 1) digitized coordination of therapists and consolidation of patient data in an online pain management platform, 2) optimized and individualized care plans pushed to the patient’s smartphone app, 3) integrated assessments and questionnaires for quality of life, pain, function, or mental health to optimize therapy plans, 4) integration of pVNS in treatment plans to allow for improved and sustained patient outcomes, 5) remote monitoring of the patient at home, education, and engagement, e.g., to perform exercises, via the smartphone app to improve long-term outcome also after the end of the four-week program.

Conclusions

Thorough follow-up on patients, data collection, and interdisciplinary coordination of the involved doctors and therapists can make a significant contribution to therapy outcomes in CLBP [5, 6]. This can be improved by user-centric design of digital tools as documentation, coordination and evaluation of therapy and relevant outcome parameters is key to an effective, individual care. Data integrity and follow-up, even after the end of a multimodal 4-week therapy program will allow for sustained outcomes and optimized aftercare. Inclusion of pVNS in therapy plans, as an add-on minimal-invasive neuromodulation therapy, holds promise to improve responder rate and patient’s outcome. Recent studies have shown that pVNS can significantly improve outcomes in CLBP patients when combined, e.g., with physiotherapy [8, 9]. We expect an improvement in workflows, quality of care, and potential for cost reduction with the successful implementation of this project.

References

1. T. Vos et al (2017). https://doi.org/10.1016/S0140-6736(17)32154-2.
2. https://www.nytimes.com/2017/10/26/us/opioid-crisis-public-health-emergency.html.
3. N. Corp, G. Mansell, S. Stynes et al (2021). https://doi.org/10.1002/ejp.1679.
4. Report zum Update der evidenz- und konsensbasierten Österreichischen Leitlinie für das Management akuter, subakuter, chronischer und rezidivierender unspezifischer Kreuzschmerzen 2018 – Kurzbezeichnung Leitlinie Kreuzschmerz 2018, Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz, Leitlinienreport 1. Auflage, Version 1, 2019.
5. T.R. Toelle, D.A. Utpadel-Fischler, K.K. Haas et al (2019). https://doi.org/10.1038/s41746-019-0109-x.
6. Ziele in der Behandlung chronischer Schmerzen. Schmerz Nachr (2023). https://doi.org/10.1007/s44180-023-00158-8.
7. S. Kampusch, K. Edegger, P. Mayr et al (2022). https://doi.org/10.3233/SHTI220378.
8. S. Ünal, D. Coskunsu, S. Hatik, A. Özden (2022). https://doi.org/10.18621/eurj.1005161.
9. J. Szeles, S. Kampusch, V.H. Le et al (2021). Clinical Effectiveness of Percutaneous Auricular Vagus Nerve Stimulation in Chronic Back Pain Patients – A Single-Centre Retrospective Analysis. Annals of Pain Medicine, vol. 3(1), 1009.

Presenting Author

Rudolf Likar

Poster Authors

Caroline Stremnitzer

Mag PhD

Aurimod GmbH

Lead Author

Angelika Rzepka

DI

AIT Austrian Institute of Technology GmbH, Graz, Austria

Lead Author

Rudolf Likar

Prim. Univ.-Prof. Dr. MSc.

Department for Anaesthesia and Critical Care, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria

Lead Author

Van Hoang Le

DI

Aurimod GmbH

Lead Author

Klaus Zeiner

DI

Aurimod GmbH

Lead Author

Patrick Mayr

MSc

AIT Austrian Institute of Technology GmbH, Graz, Austria

Lead Author

Karl Kreiner

MSc

AIT Austrian Institute of Technology GmbH, Graz, Austria

Lead Author

Stefan Kampusch

AURIMOD GmbH

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Neuromodulation