More than 50 million Americans suffer from chronic pain linked to common conditions such as spine disorders, osteoarthritis, neuropathy and headaches, adding up to an estimated cost of $70 billion per year. Treatment may include several types of medication, physical therapy, massage and exercise, psychological counseling and relaxation, and spiritual practices like meditation and yoga. With all of these options, optimizing the treatment of chronic pain remains a significant challenge for both people living with pain and their primary care providers, who are responsible for most routine pain care.
A detailed, accurate history of a patient’s pain experience (including what makes pain better or worse), physical functioning and response to therapies is essential for effectively managing pain, but there are many barriers to getting patients to communicate this history—and getting providers to hear and interpret it wisely. Patients in pain may have limited capacity for recall and/or lack communication skills to convey specific details regarding pain experiences. Clinic encounters are limited in time, and many providers have limited experience in pain management. Typical pain and function questionnaires, completed weekly, monthly or at the end of the day, cannot possibly capture all essential details of the pain experience as it unfolds and changes, sometimes by the minute, throughout the day and night.
As part of Project HealthDesign, the team based at the University of Massachusetts Medical School has developed a handheld electronic pain and activity diary (EPAD) that will interact with an electronic personal health record (PHR). Built on a personal digital assistant platform and customized to users’ typical experiences, the EPAD application allows people with pain to record structured information on their pain experience, treatment and physical activities every two hours throughout the day. The EPAD will allow people living with pain to generate rich and accurate information that can be used by their health care providers, as well as to help patients to learn about their own pain triggers, treatment effects and temporal pain patterns. The team is also working on developing software that will automate the analysis of information captured in the EPAD to offer patients and providers key insights about a patient’s pain and treatments informed by best practices in pain management. In the next phase of this project, the team will field test the EPAD and analyze data about how well the device helps patients and their caregivers manage medications and control chronic pain.
Roger Luckmann, M.D., M.P.H.
Department of Family Medicine and Community Health
University of Massachusetts Medical School
55 Lake Avenue North
Worcester, MA 16155