How much do you ache? Bracelet plus app records pain in real-time
An assessment system consisting of a wearable device and a smartphone app promises reliable recording of pain in individuals with chronic pain, including fibromyalgia. The resulting data accurately reflect pain status and help alleviate pain, according to the results of a pilot study.
Referred to as the Pain Assessment and Analysis System (PAAS), the device is a bracelet that features a button for reporting pain severity at 10 distinct levels. This bracelet connects to the smartphone application, where reports are summarized and presented.
PAAS creates reports on the frequency and severity of pain, shown in graphs based on daily, weekly or monthly time intervals. Additionally, it records the time, temperature, humidity and weather at the time the pain is reported, and identifies any correlations with these environmental factors.
“Chronic pain is a debilitating condition which should be managed with integrated multidisciplinary approaches. To this end, accurate pain assessment should be the first step,” the investigators said. “Self‐reporting pain assessment systems using smartphones or wearable devices—that can reflect real‐time pain severity and frequency and can analyse the pattern of impacting factors—can be used to provide effective treatment and to eventually improve patient pain.”
To test the utility and efficacy of PAAS, the investigators enrolled 25 fibromyalgia patients in a 3-month trial—14 were randomly assigned to the group that used the system and 11 to the control group administered usual treatment only. The average age of the cohort was 42 years, and all patients were female.
After 3 months, a substantial reduction in the visual analogue scale (VAS) for pain, the primary endpoint, was observed in the PAAS group (mean difference from baseline, −8.3). In comparison, the pain VAS score in the control group increased by a mean of 5.5 (PAAS vs control, p=0.048). [Int J Rheum Dis 2019;doi:10.1111/1756-185X.13472]
The mean pain VAS calculated by PAAS strongly correlated with the mean conventional pain VAS calculated at the clinic (p=0.0003). But compared with the latter, PAAS-calculated mean pain VAS showed better correlation with fibromyalgia disease activity, as well as with physician and patient global assessments.
Meanwhile, no clear pattern was established with respect to pain and specific environmental conditions due to the small number of patients. “It will be intriguing to determine if pain worsens at dawn or with low air pressure on rainy days with the visualized real‐time data,” the investigators said.
“We expect that our system can be not only applied to fibromyalgia patients, but also to patients with other diseases that involve acute pain such as chest pain, cancer breakthrough pain or postoperative pain,” they continued. “One of the advantages of our PAAS system is that real‐time pain can be easily reported using the wearable device,” diminishing recall bias between visits.
On the other hand, PAAS does not adopt a feedback system, which is perhaps an important limitation. In the absence of such a system, "we provided patients with detailed reports of pain analysis during the study period at the last visit,” they said.
The investigators believe that the efficacy of PAAS can improve even more with the incorporation of a feedback system. Some of these systems adopt a remote consulting approach (eg, automated feedback and man-to-man contact) to provide an immediate response.