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APP REVIEWS

Chronic Pain (Revisited)

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Dr. Stephen Pomedli
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This review is an updated version of the Chronic Pain review posted in May, 2017

Chronic pain is a complex experience, with multiple causes, variations in symptoms and many factors and treatment modalities that may better, worsen, or not affect the pain at all. This can make monitoring and reducing pain quite challenging [1, 2].

Smartphone apps can potentially assist with chronic pain management in three key ways, by

1. tracking symptoms over time to reveal associations between symptoms and alleviating or aggravating factors;

2. communicating this information with health professionals to develop a shared understanding of the pain experience, and to assess future therapeutic options; and

3. giving timely and relevant information, support, strategies and coaching for self-management [3, 4].

While none of the five top chronic pain apps reviewed here excel at all three of these, certain apps stood out within a more limited scope. Manage My Pain and Chronic Pain Tracker are the notable tracking apps that have deep enough features and strong reporting functions to delve into the complexity of chronic pain and communicate this to physicians in an effective way that could impact management. Similarly, Pain Coach provides a bevvy of information and techniques to support self-management, while CatchMyPain has a strong online support community. Importantly several of these apps explicitly share user information with research bodies or pharmaceutical companies, or have some element of advertising, and thus should be recommended with these cautions. Also, many of these apps involve sending patient symptom reports via email — rarely with any clear guidance on the use of this potentially unsecure channel. However, with this understanding, these apps may still lend important support to certain patients — whether by improving self-management in between clinic visits, giving deeper insights into trends and associations, or assisting doctors better understand the complexity of the patient’s pain experience.

Apps Reviewed

CatchMyPain
3.5 stars3.5 stars3.5 stars3.5 stars3.5 stars
Manage My Pain
3.5 stars3.5 stars3.5 stars3.5 stars3.5 stars
Pain Coach
3.5 stars3.5 stars3.5 stars3.5 stars3.5 stars
Chronic Pain Tracker
2.5 stars2.5 stars2.5 stars2.5 stars2.5 stars
My Pain Diary
2.5 stars2.5 stars2.5 stars2.5 stars2.5 stars

Chronic Pain Tracker

2.5 stars2.5 stars2.5 stars2.5 stars2.5 stars

Along with the usual tracking features, such as daily reminders and symptom customizability, this pain tracking app has 19 different “modules” that track everything from fatigue levels and sleep quality to weather patterns. This breadth attempts to address the complexity of chronic pain, though some modules are definitely not as rigorous as others. Chronic Pain Tracker also encourages the use of multiple simultaneous “Pain Diaries” to track the elements and trajectories of different types of pain, for example, tracking migraines and knee pain at the same time. The reports are very detailed and a definite strength of this app, and could be very useful in sharing information with providers. The major drawbacks relate to the busy interface and the lack of any privacy policy.

Detailed Review View All

Features

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A simple but key differentiating feature here is being able to track “Milestones”, such as a medical procedure or important life event, and generate comparison reports before/after this marker. These can provide very useful insights into the factors impacting longer-term pain trends. Being able to easily access previously generated reports directly from the app is another nice feature. Another unique element is the use of certain dermatome maps or muscle anatomy renderings so as to be able to “draw” pain locations onto specific body regions, which may be especially helpful for certain pain conditions.

Effectiveness

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The reports are especially useful in trying to understand complex chronic pain conditions and do well in showing possible correlations between the various types of symptoms being recorded. Similarly, if medications are being tracked by the patient, the reports try to establish the impact of the medications on pain levels. There isn’t any mention that this app was developed in conjunction with patients, physicians or other health professionals.

Usability

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Despite the great functionality, the interface is very busy and cluttered. The bright colours and competing “thumbnail” images make it feel that there are too many things to interact with at any given time. There is a detailed user guide in the app and video tutorials are also available online.

Privacy & Security

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No privacy policy is available, and there isn’t any provision to limit access to the app via a password. Reports are emailed directly from the app and data can be stored on Dropbox — though there are no mentions about the security and privacy questions surrounding these means of data transmission and storage.

Reliability

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The app was generally very reliable, and the development team has updated it within the last 6 months. One concern is that when entering a potential “red flag” symptom as part of a tracking module, the app does not specifically direct you to discuss this further with a health professional.

Accessibility

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Chronic Pain Tracker is available only for Apple devices, but is available in both English and French. Upgrading to PRO for $13.99 is a bit steep, but allows for generation of additional report types, keeping multiple different pain diaries and logging more than 20 diary entries. The user guide has options to increase font size for readability.

My Pain Diary

2.5 stars2.5 stars2.5 stars2.5 stars2.5 stars

A straightforward pain tracking app with a very narrow feature set, but the features seem to generally work quite well. The app only has a few truly unique features – such as creating customized push notifications, including photos with entries, keeping certain diary entries private, and choosing to include or exclude them from reports or graphs – which are not huge differentiators. While My Pain Diary tries to make associations and correlations between symptoms and other trends, including affective state and weather patterns, it falls short by not having more advanced medication tracking options or ways to log the other treatments, life events, or stressors that often affect chronic pain. While the app isn’t intended to provide pain-specific support or knowledge, it misses key opportunities to educate and encourage self-management.

Detailed Review View All

Features

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The app lets the user track multiple pain types simultaneously, e.g. pain related to migraines and fibromyalgia pain, and allows the user to visualize these trends together or individually. A new feature encourages tracking of mood symptoms like depression or anxiety which is helpful given potential associations with pain intensity. Being able to preview pdf reports or graphs before sending these off is a nice feature to ensure that you are exporting the correct data.

Effectiveness

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While developed by a patient with deep lived experience with chronic pain, there isn’t any mention of specific clinical guidance in the development of the app. The lack of rigorous tracking of medications and medication side effects may limit the clinical usefulness of the reports.

Usability

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The app is relatively straightforward to use, and a mini-onboarding sequence is helpful to get started. The new “Gold” version, available for iOS, has one of the best looks and feels among this group of apps — an elegant interface that is intuitive and utilizes many of the gestures and elements familiar to the iOS environment. Unfortunately, the Android app retains a rather dated appearance and interface with many competing graphics, making the screen feel cluttered most of the time.

Privacy & Security

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The privacy policy explicitly states that while aggregated and anonymized usage information is available to the developers, data added to the app by the user remains private and isn’t available to anyone, including third parties. Of note, the user can set a password to limit access to the app.

Reliability

+-

An initial disclaimer does suggest connecting with a physician to help determine a pain tracking strategy and the app is pitched and structured specifically as a way to share information with clinicians. The app has been updated within the past six months, though the most recent update is only available on iOS.

Accessibility

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My Pain Diary is available for both Android and Apple, but only in English. The download cost is modest – between $5 and $7 – though many users often prefer to try apps before buying which isn’t an option here.

CatchMyPain

3.5 stars3.5 stars3.5 stars3.5 stars3.5 stars

The stand-out feature of CatchMyPain is the discussion forum and community, which provide tips from fellow chronic-pain-trackers, as well as support, validation, and often, camaraderie. Importantly, these forums seem to be quite active and well-moderated to keep comments on topic, respectful, and relevant. The pain tracking features are quite basic with reports that are likely a bit too simplistic, and there is no vetted information to support self-management. As this app was developed in partnership with pharmaceutical companies, certain profile information seems to be collected solely for the use of these groups and less so for the users’ benefit. It is important that patients be aware of how their data will be used by these third parties.

Detailed Review View All

Features

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Aside from the well-developed forums — recent topics include “Best pain scale ever” “Fibro pain and Migraine” and “What makes you smile?” — the pain tracking in this app focuses on the location of the pain, allowing the user to paint a “heat map” of the pain on an avatar. Interestingly, these heat maps become the “profile images” for users in the community forum, so it can be easy to find and talk with users who have similar pain manifestations. The diary also facilitates tracking medications, and offers an inexpensive add-on to provide reminders for regular medications — a nice option.

Effectiveness

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It is unclear if any clinical input was involved in the development of the app. One clear drawback that limits the clinical usefulness is that the medication tracking elements seem completely separate from the pain tracking functions. Like any other open discussion forum, there is always some concern that such venues might suggest and sustain maladaptive behaviours or promote incorrect information. However, the benefits of the support provided in the community likely outweigh the drawbacks, but cautions should be raised around this.

Usability

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CatchMyPain provides a nice onboarding sequence to teach the user how to use the app, walking through the steps one-by-one. Even without this, the minimal and sparse aesthetic throughout make use a breeze, even when adding and viewing posts in the discussion forum. Some of the symptom analyses aren’t readily accessible via the app and require emailing reports, which is a bit cumbersome.

Privacy & Security

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A privacy policy is presented upon first opening the app, and does disclose that anonymized data may be shared with similarly affected patients, other professionals, researchers, and manufacturers of medical products, but also notes that it cannot guarantee the anonymity of the profile or health data. Of note, CatchMyPain is one of the few apps that confirms that you are about to send an email, explaining what the recipient will be able to view. And the app allows the user to limit how many days the report will be viewable, which is a nice security bonus.

Reliability

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The app does initially note that it is intended to provide “information not advice”, though this disclaimer disappears after the first log-in. The app appears to be updated frequently, and there are easy ways to provide direct feedback to the app creators. The app didn’t have any bugginess, though occasionally the emailed reports took several attempts before they loaded.

Accessibility

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CatchMyPain is available in both English and French, and for both Apple and Android. In-app purchases, for $3.99 each, include stress, fatigue and weather tracking, along with the medication reminder described above.

Manage My Pain

3.5 stars3.5 stars3.5 stars3.5 stars3.5 stars

Manage My Pain is designed to “track, analyze and share” pain symptoms, and does this admirably, producing clean and useful reports to communicate with medical professionals, without unnecessary bells and whistles. A new functionality uses a Daily Reflection to track “Meaningful Activities”. This helps go beyond just pain reporting and logs whether or not the user is still able to engage in meaningful activities, the ultimate goal of chronic pain management often overlooked by other tracking apps [5]. The app doesn’t provide any supports for self-management or educational information related to specific pain syndromes.

Detailed Review View All

Features

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One of the unique tracking categories is “Ineffective Therapies”, which is often important for patients and providers alike when trying to select future therapeutics. Recording the specifics of the setting/environs when the pain is occurring could be a helpful tracking metric. Beyond this, the app offers the usual tracking options and customizable lists of symptoms, medications and treatments.

Effectiveness

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Several features of the app have been designed in conjunction with a multidisciplinary team with expertise in pain treatment, including anesthesiologists, nurse practitioners, and psychologists, and the app is currently part of a trial to assess its impact on pain, function, medication use and user satisfaction – it will be intriguing to see these results!

Usability

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Manage My Pain has one of the best interfaces with its simple, intuitive and clean design, very easy to navigate. Healthcare providers will appreciate the useful reports, which are adequately detailed but remain concise. As is common, the web-app for iOS users isn’t as slick as the native app and has more limited functionality.

Privacy & Security

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The app provides its plain language privacy policy up front when first loading the app, which is a welcome approach. However, the policy does specifically note that de-identified, aggregated data will be shared with third parties, such as pharmaceutical companies. Emailed reports require a password before accessing this information outside the app, which ensures this information ends up in the right hands.

Reliability

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The app has been updated within the last six months. The app is generally smooth to use; emailed reports arrived within a few minutes of generation. Feedback can be emailed to the developers directly from the app.

Accessibility

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The app is only available on Android, but is also accessible by iOS devices and desktop browsers via the new web app. In addition to French and English, the app is also available in five other languages, including Spanish and simplified Chinese. Of note, the Android app can be used entirely offline – which may be helpful if there is limited connectivity. Most users will find it necessary to upgrade to the Pro version, $3.99, which allows viewing more than 10 pain records. Further, there may be some ongoing costs; generating certain advanced reports costs up to $1.49 per report.

Pain Coach

3.5 stars3.5 stars3.5 stars3.5 stars3.5 stars

Pain Coach is part of WebMD’s suite of online health information. It probably has the best and deepest resources for providing educational materials and tips for the self-management of pain – though the pain tracking and goal setting modules are less well-developed. The majority of the informational articles name the physician or health professional who reviewed that specific section, which lends credibility. However, the app also functions as a portal to WebMD’s main site via the app, which seems less rigorously reviewed and sometimes cites less reliable sources, not to mention that the website is rife with ads for health products and services. Any user of this app should be aware of this advertising slant and that their data may be used for marketing purposes, as cited in the privacy policy.

Detailed Review View All

Features

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The user can select the type(s) of chronic pain he or she is experiencing, e.g. back pain, fibromyalgia, rheumatoid arthritis, when first opening the app, and the app selectively presents the educational information most relevant to these conditions. The app does help track the basic pain parameters, including specific triggers and treatments, though doesn’t allow reporting of the pain’s location, aggravating factors, mood or overall functional levels. The module for goal-setting simply suggests goals based on the types of pain being experienced, and the goals are just “achieved” after a set period of time, lacking the effective rigour of the “SMART” framework for goal-setting [3].

Effectiveness

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While much of the content seems well-reviewed, the lines are blurred between this content and the more nebulous web-based information, which may make physicians hesitant to endorse the app. Aside from the content, it isn’t clear if any clinical input was part of the development process. Despite the tracking functions, the resultant graphs intended to be shared with doctors seem over-simplified which may limit their clinical utility.

Usability

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It is very simple to click through and discover new information and tips to improve health and reduce pain – grouped in five categories: treatments, mood, food, rest, and exercise – with a clean and straightforward interface. However, the wealth of information is invariably presented in paragraphs of smallish text, which quickly become tedious to read. When wandering into the web-based portion of the app, certain screens loaded erratically and almost seemed designed to make the user accidentally click on ads.

Privacy & Security

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Importantly, the app presents a privacy policy and a plain-language summary to make it more understandable, though the policy does disclose that information collected by the app is used for targeted advertisement and marketing purposes. There isn’t any mention of email security when emailing out reports. Like most other apps here, the user can set a password to restrict app use.

Reliability

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This is one of few apps to have a prominent and consistently present disclaimer that the app “is not a substitute for professional medical advice” and directs the user to 911 if there is a health emergency. In general, the app was smooth to use with no bugginess and there is an easy mechanism to provide feedback to the team behind the app.

Accessibility

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Pain Coach is available on both Android and Apple for free, but is unfortunately only available in English. The text is generally written at an accessible level, but the small text size is not visually friendly to all users.

What Experts Say

Watch our interview with chronic pain consultant, and medical director, Dr. Jackie Gardner-Nix about chronic pain.

Patient Experiences

As if the most recent (2017) Canadian opioid-prescribing guidelines – which encourage doctors to avoid powerful narcotics for patients with chronic, non-cancer pain – were not enough, the pervasive news about an opioid crisis should tip the balance toward other medications or non-pharmaceutical therapies. Fortunately, when it comes to non-pharma support, there’s are apps for that.

More accurately, there are hundreds of apps for that. With the caveat that the majority were not developed with healthcare professional involvement and, therefore, lack features that would be ideal in pain management – see our reviews – there is evidence that internet-based cognitive behavioural therapy (CBT) can significantly decrease pain levels, improve function, and decrease costs compared to standard care.

That’s the conclusion of Robert Jamison, PhD, professor of anesthesia and psychiatry at Harvard Medical School and pain psychologist with Brigham and Women’s Hospital. In 2014, he told the American Pain Society’s annual meeting that “Online networks, for example, can promote communication, distraction, information sharing, self-expression and social support. We also believe online networks decrease feelings of withdrawn behaviour and instill a greater willingness to return for treatment.”

Later, Jamison was lead author on A Pilot Comparison of a Smartphone App with or without 2-way Messaging Among Chronic Pain Patients: Who Benefits from a Pain App? Published in the November 2016 Clinical Journal of Pain, the study found that the smartphone pain app developed for the study was usable, valid, reliable, and easily accepted among patients and providers alike. Patients who were the least active derived the most satisfaction with the pain app.

“Quite possibly those patients who are very active and less disabled from their pain did not like to focus on and continually rate their pain, sleep, activity interference, or mood compared with those who were more disabled due to their pain. Those who could do very little during the day and showed significant daily disruption of their activity seem to appreciate the pain app more. Quite possibly these individuals gained some personal benefit in relaying their information to family members and to their providers.”

In fact, a study funded by the Research Council of Norway tested the usability of “written online situational feedback via mobile phone”, learning that participants found it useful to fill out the diaries because it increased awareness of their own reaction to the pain and it supported the use of positive coping strategies. The app’s feedback messages were experienced as personal and relevant to the current situation, with a suitable mix of praise, encouragement and CBT exercises.

One participant said she felt she could be more honest when filling out the diaries than she would have been in a face-to-face setting. Another said she felt the intervention had motivated and helped her to integrate what she had learned at a rehabilitation centre, finding it supported establishing new health behaviour.

References

  1. Moulin et al. Pharmacological management of chronic neuropathic pain: Revised consensus statement from the Canadian Pain Society. Pain Res Manag 2015;19(6):328-335.
  2. Kahan et al. Canadian guideline for safe and effective use of opioids for chronic noncancer pain. CFP 2011;57:1257-66.
  3. Stinson et al. iCanCope with Pain: User-centred design of a web- and mobile-based self-management program for youth with chronic pain based on identified health care needs. Pain Res Manag 2014;19(5):257-265.
  4. Lalloo et al. “There’s a Pain App for That” Clin J Pain 2015;31:557-563.
  5. Rini et al. Meeting them where they are: Using the INternet to deliver behavioral medicine interventions for pain. TBM 2012;2;82-92.
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