Benjamin A. Rosser

Smartphone applications for pain management

Smartphone applications (or apps) are becoming increasingly popular. The lack of regulation or guidance for health-related apps means that the validity and reliability of their content is unknown. We have conducted a review of available apps relating to the generic condition of pain. The official application stores for five major smartphone platforms were searched: iPhone, Android, Blackberry, Nokia/Symbian and Windows Mobile. Apps were included if they reported a focus on pain education, management or relief, and were not solely aimed at health-care professionals (HCPs). A total of 111 apps met the inclusion criteria. The majority of apps reviewed claimed some information provision or electronic manual component. Diary tracking of pain variables was also a common feature. There was a low level of stated HCP involvement in app development and content. Despite an increasing number of apps being released, the frequency of HCP involvement is not increasing. Pain apps appear to be able to promise pain relief without any concern for the effectiveness of the product, or for possible adverse effects of product use. In a population often desperate for a solution to distressing and debilitating pain conditions, there is considerable risk of individuals being misled.

Technologically-assisted behaviour change: a systematic review of studies of novel technologies for the management of chronic illness

A systematic review was conducted to investigate the use of technology in achieving behaviour change in chronic illness. The areas reviewed were: (1) methods employed to adapt traditional therapy from a face-to-face medium to a computer-assisted platform; (2) targets of behaviour change; and (3) level of human (e.g. therapist) involvement. The initial literature search produced 2032 articles. A total of 45 articles reporting 33 separate interventions met the inclusion/exclusion criteria and were reviewed in detail. The majority of interventions reported a theoretical basis, with many arising from a cognitive-behavioural framework. There was a wide range of therapy content. Therapist involvement was reported in 73% of the interventions. A common problem was high participant attrition, which may have been related to reduced levels of human interaction. Instigating successful behaviour change through technological interventions poses many difficulties. However, there are potential benefits of delivering therapy in this way. For people with long-term health conditions, technological self-management systems could provide a practical method of understanding and monitoring their condition, as well as therapeutic guidance to alter maladaptive behaviour.

e-Health and chronic pain management: current status and developments.

There are significant geographic, economic, and educational barriers for patients with chronic pain accessing evidence-based treatments. Recent developments in computing and sensing technologies have led to applications facilitating the management of other long-term health conditions such as diabetes, stroke, heart failure, and depression. Technology could also offer promising solutions to the management of chronic pain conditions and the current barriers of access. A number of technologies are being explored worldwide with a variety of goals. In what follows we focus largely on electronicbased innovations offered as part of a solution for the management of chronic pain. For ease of narration we adopt the term ‘e-health’ to encompass developments labelled variously as ‘telemedicine’, ‘telehealth’, ‘telecare’, ‘assistive technology’, ‘cybertherapy’. We aim to (i) introduce and scope the developing field, (ii) review the extant projects in pain, drawing on basic science, clinical case studies and where available treatment intervention trials, (iii) summarize e-health advances being explored with chronic conditions other than pain that may provide opportunities for developments in chronic pain management, (iv) critically appraise current technological developments as they might apply to pain, and (v) discuss challenges to further development.

Concerns about medication and medication adherence in patients with chronic pain recruited from general practice.

&NA; This study examines the concerns and beliefs about medication reported by patients with nonmalignant chronic pain encountered within general practice. Two hundred thirty‐nine patients with chronic pain took part in this research. Patients completed the Pain Medication Attitudes Questionnaire, a measure of patient concerns and beliefs relating to addiction, withdrawal, side effects, mistrust in doctors, perceived need of medication, scrutiny from others, and tolerance. The data revealed that patient concerns and beliefs predicted general medication nonadherence. In addition, concerns were related to the direction of nonadherence: overuse of medication was related to increased perceived need for medication and greater concern over side effects; underuse was related to decreased concerns over withdrawal and increased mistrust in the prescribing doctor. Analyses also indicated that patient attitudes and concerns about medication were more predictive of nonadherence than both level of pain and the reported frequency of experienced side effects. This research contributes to the increasing evidence that patient attitudes and beliefs about pain medication are associated with adherence behavior. Training general practitioners to identify and address these concerns may reduce concerns, improve adherence, and facilitate the doctor–patient relationship. Patient concerns about medication predicted nonadherence, including both over‐ or underuse. Concern appeared more predictive than both pain intensity and frequency of side effects experienced.

Technology-Mediated Therapy for Chronic Pain Management: The Challenges of Adapting Behavior Change Interventions for Delivery with Pervasive Communication Technology

OBJECTIVE Adapting therapeutic practice from traditional face-to-face exchange to remote technology-based delivery presents challenges for the therapist, patient, and technical writer. This article documents the process of therapy adaptation and the resultant specification for the SMART2 project-a technology-based self-management system for assisting long-term health conditions, including chronic pain. MATERIALS AND METHODS Focus group discussions with healthcare professionals and patients were conducted to inform selection of therapeutic objectives and appropriate technology. RESULTS Pertinent challenges are identified, relating to (1) reduction and definition of therapeutic objectives, and (2) how to approach adaptation of therapy to a form suited to technology delivery. The requirement of the system to provide dynamic and intelligent responses to patient experience and behavior is also emphasized. CONCLUSION Solutions to these challenges are described in the context of the SMART2 technology-based intervention. More explicit discussion and documentation of therapy adaptation to technology-based delivery within the literature is encouraged.

Attentional and interpretative biases in appearance concern: An investigation of biases in appearance-related information processing.

The present study examined associations between high levels of appearance concern and information processing biases in interpretation and attention. An opportunity sample (N=79) categorised ambiguous stimuli as related or unrelated to appearance. Participants then responded to the same stimuli in a modified visual dot-probe task assessing attentional bias. Participant responses were assessed in relation to level of appearance concern. The results indicated a valence specific bias towards interpretation of ambiguous stimuli as negative and appearance-related in individuals with higher levels of concern. There was also evidence of attentional bias towards information perceived as appearance-related in participants with higher levels of appearance concern. The study findings suggest that association between appearance-orientated information processing biases and level of appearance concern; this association may lead to mutually reinforcing bias and concern.

Searching the Internet for help with pain: Adolescent search, coping, and medication behaviour

OBJECTIVES To explore a community sample of adolescents for engagement with online pain resources. To assess if the use of the Internet to search for health information correlated with measures of coping, risk taking, catastrophizing about pain, and engaging in the self-management of pain. DESIGN A cross-sectional online study of community-based adolescents (n = 105) recruited via schools to examine their use of the Internet to seek pain-related information. METHODS Adolescents completed questionnaires of pain coping, catastrophic thinking, risk-taking behaviour, and medication use. Descriptive analyses were undertaken on event rates of pertinent behaviours, principally on information seeking and pain management behaviour. Correlational analyses were undertaken between coping and information seeking, and medication use. RESULTS Few participants engaged in online pain information seeking. Those who did were more likely to be female and scored higher on medication use, catastrophizing, risk taking, and the total score on the Pain Coping Questionnaire. CONCLUSIONS Although adolescents are high users of the Internet, paradoxically they do not appear to use the Internet for information about pain and pain management. Further research should assess inhibitory and disinhibitory factors associated with information seeking about pain and chronic illness on the Internet. STATEMENT OF CONTRIBUTION What is already known on this subject? Internet use in adolescents is common, mobile, and displays a level of technical awareness unparalleled by adults. The internet is postulated in previous research to present a platform for the delivery of health care, particularly information to aid health decision-making for young people. What does this study add? This study explores how adolescents use the internet to look for health information, particularly on pain and where this falls in a general profile of coping with illness. Interestingly and counterintuitively, adolescents did not use the internet to look for health or pain information. We hypothesize that there may be something about information on pain management that does not readily transfer to the digital world in a way that is useful to adolescent users.

Internet Sites Offering Adolescents Help With Headache, Abdominal Pain, and Dysmenorrhoea: A Description of Content, Quality, and Peer Interactions

OBJECTIVES To analyze content and quality of headache, abdominal pain, and dysmenorrhoea websites, and to thematically analyze online pain forums. METHODS Websites offering support, advice, or information regarding pain were explored. Websites were analyzed quantitatively using the Health-Related Website Evaluation Form and the DISCERN scale. Websites containing forum functions were thematically analysed assessing how the Internet is used for support and advice. RESULTS 63 websites were included. Few websites scored in the upper quartiles of scores on the measures. 7 websites contained supportive posts, pertaining only to dysmenorrhoea. The ways users cope and the coping judgements of other forum users are presented thematically. 3 themes emerged: (1) passively engaged postings, (2) actively engaged postings, and (3) reactively engaged postings. CONCLUSIONS Internet pain resources are of low quality and questionable value in providing help to adolescents. Future research should explore how to improve quality.

The Moderated Relationship of Appearance Valence on Appearance Self Consciousness: Development and Testing of New Measures of Appearance Schema Components

This paper describes the creation and psychometric properties of two independent measures of aspects of appearance schematicity – appearance salience and valence, assessed by the CARSAL and CARVAL, and their relation to appearance self-consciousness. Five hundred and ninety two participants provided data in a web based task. The results demonstrate the sound psychometric properties of both scales. This was demonstrated by good item total characteristics, good internal reliability of each scale, and the independence of the two scales shown through principal components analysis. Furthermore, the scales show independent and moderated relationships with valid measures of appearance related psychosocial distress. Negatively valenced appearance information was associated with increased appearance self-consciousness. More crucially, the impact of negative valence on appearance self-consciousness was exacerbated by the moderating effect increased salience of appearance.

Promoting self-management through technology:SMART solutions for long-term health conditions

Technology in various forms is being developed and applied to provide new solutions to the increasing prevalence of long‐term health conditions. This article describes the potential of telehealth and telecare applications in response to increased demands for health and social care. The impact of technology on provision of person‐centred treatment and self‐management is described using the emergent results from the SMART2 project. SMART2 is a multi‐disciplinary collaboration which spans academia, health providers and people with long‐term conditions.