JMIR Publications

ABSTRACT

Background:

Digital pain mapping allows for ecological momentary assessment of pain intensity and distribution to be acquired from patients over multiple time points spanning days to months. A remote assessment may reveal changes, tendencies and fluctuations more clearly, as acquired over the continuous time-dependent, and lead to insights about the trajectory and management of a patient’s pain.

Objective:

The primary aim was to remotely map and track the intensity and distribution of pain and discomfort (e.g. burning, aching, tingling) in patients with non-malignant spinal referred pain over 12 weeks, using a web-based app for digital pain mapping. The secondary aim was to explore barriers of use of the mapping app among these patients by determining differences in clinical and user characteristics between those with good reporting compliance (regular users) and those poor reporting compliance (non-regular).

Methods:

Patients (N=91, 53 female) with spinal referred pain were recruited from an online and a traditional in-house strategy. Patients were asked to submit a weekly digital pain report for 12-weeks. Each pain report consisted of digital pain drawings on a pseudo-3D body chart, reporting the pain and discomfort distribution (total extent and location), pain intensity, and discomfort (quality descriptors). Differences in weekly pain reports were explored using the total extent (pixels), current and usual pain intensity ratings, frequency of quality descriptors selection, and Jaccard similarity index. Electronic questionnaires were completed at baseline to determine the patients’ characteristics, disability, and pain catastrophizing profiles. Barriers of use were assessed at 6-weeks using healthcare-related usability and acceptance questionnaire, as well as a technology-specific electronic questionnaire. Associations between total extent, pain intensity, disability and catastrophizing were explored to understand pain further. Differences between regular and non-regular users were assessed to understand the pain mapping app reporting compliance.

Results:

Fluctuations were identified in pain reports for total extent and pain intensity ratings (P<.001). However, quality descriptor selection (P=.99) and pain drawing (P=.49), as compared using the Jaccard index, were similar over time. Interestingly, current pain intensity was greater than usual pain intensity over time (P<.001), suggesting the timing of pain reporting coincided with a more intense pain experience than usual. Usability and acceptance were similar between regular and non-regular users. Regular users were younger (P<.001), and reported a larger total extent, than non-regular users (P<.001).

Conclusions:

This is the first study to examine pain intensity and distribution in pain reports, barriers to use and compliance from the patients’ home using a digital mapping pain app, for a sustained period. Differences in age and pain distribution may influence reporting behavior and compliance. Clinical Trial: ClinicalTrials.gov NCT03926364.