Canadians with chronic pain to test app to manage symptoms
Doctor encouraged by how patients better understand their own symptoms
Chronic neck, back and shoulder pain have forced Terry McLaughlin to take narcotics in order to function but the 64-year-old says he's loathe to become dependent on opioids.
And so the northern Ontario man says he diligently logs his pain level on a mobile app that can also record sleep habits and activity level.
He says it keeps him from increasing his dosage, and helps him understand what triggers his symptoms and why.
"The more I communicate with the app the better it is for me because I can always go back and see, 'OK, this has helped me. How do I make it better? If [my pain level] is a seven today, let's try to make it a six tomorrow,"' says McLaughlin, adding that sleep quality as well as temperature and humidity can affect whether he has a good day or a bad one.
"You know what you did wrong and you correct it because you don't want to have to take that pill early."
McLaughlin lives in Val Gagne, Ont., about 50 kilometres east of Timmins and 15 kilometres south of Iroquois Falls, where his doctor is based.
He's among 250 patients taking part in a clinical trial testing whether the app can help manage chronic pain, with 84 of those patients drawn from the Iroquois Falls Family Health Team.
Although the project is still gathering data, principal investigator Dr. Atul Prabhu is bullish on early anecdotal evidence the app appears to help some patients control their pain, better communicate their suffering to their doctor, and open up to the idea of tapering medications.
He notes that most patients otherwise recount pain episodes from memory or scattered notes, and that may be further distorted by other factors such as discomfort or exhaustion from their commute if they live far from the doctor's office.
Too often, these accounts only provide a snapshot of how the patient feels during their checkup, says Prabhu, a co-lead of program, which uses the third-party app known as Manage My Pain that anyone can download.
"We have no idea about how the patients are feeling at home, how are the patients' trajectory on a day-to-day basis," says Prabhu, deputy anesthetist-in-chief at Toronto Western Hospital.
"If they woke up at 2 o'clock in the morning in pain, they could punch that into the app and it would record so when they came to speak to one of my colleagues, they could say, 'Here's the proof, I was actually having pain and I'm better in the morning and I'm worse at night."'
Most of the study's participants are patients at Toronto Western Hospital, Toronto General Hospital and the Centenary Pain Clinic based out of the Rouge Valley Hyperbaric Medical Centre in Scarborough.
But researchers say the study is unique for including area residents of the far-flung Iroquois Falls, since such rural communities are rarely able to test new technologies or influence their development.
McLaughlin's doctor says the app appears to be especially successful in the remote community of 4,500, where 2,000 patient visits in 2017 were related to chronic pain.
Continuity of care gaps
"When I first arrived in this town I had never seen so many people with chronic pain and high-dose opiates compared to the patients that I had seen in Vancouver," says Dr. Auri Bruno-Petrina, who worked in family medicine for about seven years in Vancouver before joining the Iroquois Falls team in 2011.
"We don't have the doctor retention to offer a continuity of care and see what are the other issues. Doctors come here and go within a year, so then other doctors keep prescribing what's already on without fully assessing."
She says at least 60 of her patients have joined the trial, which began in January 2018, and estimates that half have scaled back their pain medications. The patients range in age from 40s to 80s, with most in their 60s, she says.
Taper off opiates
"Several patients of mine are tapering off opiates because they are realizing the pain medication is not helping them. There are other things in their lives that are triggering pain," she says, listing problems that mostly involve chronic back pain, but also myofascial pain and arthritic pain.
"Then I look at what part is affected — is it real pain or is it depression or is it more anxiety or sleep disturbance? Then I start to treat the other things first without even touching the pain medication because I know that's not the problem. And they agree because they can see the data — they entered the data, not me."
Patient entries are automatically available for her to review, and Bruno-Petrina can generate charts for quick analysis before seeing the patient in person. And because the data is accessible through a portal, other specialists the patient may be referred to can view their medical history without them having to rehash it all.
Prabhu says the trial wraps Jan. 8, 2020, with analysis and results expected to begin rolling out later that year.
In the meantime, Bruno-Petrina is buoyed by noticeable changes in her patients' ability to better understand their own symptoms, and the stronger bonds she's forged with them.
"What they really like is that I can see their pain," she says. "That's how they say it to me — 'Oh, now you can finally see my pain."'