The systematic review compared mHealth interventions with conventional treatment or nonintervention to determine the pain management effects of mobile-based self-management strategies.
Patients with chronic pain, such as fibromyalgia (FM), osteoarthritis (OA), and irritable bowel syndrome (IBS), using mobile health (mHealth) systems reported positive results in pain intensity and functional disability. Investigators believe these mobile-based interventions may be a valuable alternative for improving quality of life (QoL) and pain-related outcomes as well as a useful strategy for self-managing chronic pain, according to a study published in mHealth and and uHealth.1
“These systems empower patients to become more engaged and encourage self-management, improving some pain-related outcomes,” Marta Moreno-Ligero, MsC, associated with the University of Cádiz, and colleagues, stated. “Nevertheless, there is a lack of scientific and health professional support in many of the mHealth systems, highlighting the need for developing appropriate apps based on the patient’s requirements, also in the management of chronic pain.”
A systematic review of randomized controlled trials (RCTs) compared the pain management effects of mHealth interventions with conventional treatment or nonintervention. The primary outcome was pain intensity, QoL, and functional disability assessment. Investigators scoured PubMed, Scopus, Physiotherapy Evidence Database (PEDro), and Web of Science databases for appropriate studies from February to March 2022.
Eligible RCTs involved adult patients with chronic pain using mHealth systems that were compared to either no intervention or conventional treatments, such as psychological, occupational, and physical therapies, standard care, and education. The mobile-based health care apps, used on either a smartphone or tablet, were grouped into 3 categories: education, monitoring, and treatment.
Of the 885 RCTs initially identified, 22 RCTs (2641 patients) were included in the review. The average age was 38.93 years and 70.6% were female. Chronic pain conditions included chronic low back pain (CLBP), chronic neck pain (CNP), chronic musculoskeletal pain (CMSP), interstitial cystitis/bladder pain syndrome (IC/BPS), FM, OA, and IBS. Twenty-three different mHealth systems were identified, with monitoring of pain and symptoms, as well as exercise programs, reported as the most commonly used self-management strategies.
Pain intensity was evaluated in 17 (77%) of studies. For those receiving physical activity programs via mHealth interventions, pain was significantly reduced, and functional disability was significantly improved in CNP and OA when compared with standard care, although it did not improve outcomes in patients with FM. However, mHealth interventions monitoring pain and symptoms did show pain reductions in patients with FM and OA. Functional disability, which was included in 17 (77%) of RCTs, was also improved in those with CLBP and CMSP for those receiving mobile-based intervention.
A total of 15 (68%) of studies included QoL, which was mostly assessed using the 36-item Short Form Health Survey (SF-36) and EuroQoL-5D. Results showed improvements in patients with IBS, OA, and IC/BPS receiving educational interventions based on mHealth when compared with either a similar intervention or standard care.
The majority of the RCTs (82%, n = 18/22) were considered highly recommendable with a low risk of bias and were classified as medium methodological quality.
Condition-specific generalizations were not possible due to the inclusion criteria and heterogeneity of the conditions. Further, there was a risk of detection bias and performance bias as the patients were aware of the intervention and there was a lack of blinding outcome assessors.
“Despite the methodological limitations, mHealth systems seem to be a promising alternative for the management of patients with CP through a biopsychosocial framework,” Moreno-Ligero concluded. “However, further clinical studies of high methodological quality are needed to consolidate the scientific evidence and recommendations for the use of mHealth systems in patients with chronic pain.”