Abstract
Chronic pain is a debilitating condition that affects nearly one-fourth of the global population. It severely impacts an individual’s quality of life and hinders their daily activities. Managing chronic pain, however, requires personalized and participatory care, which is often challenging without constant and consistent direct supervision by a health care professional.

In this point of view, we outline how digital health platforms can help patients self-manage chronic pain. We examine the role of digitally-enabled tools to monitor pain, exercise, and treatment goals, allowing patients to positively alter their quality of life. Further, we evaluate the key features needed to ensure the successful adoption of such digital tools by chronic pain patients.

Introduction
Chronic pain is a significant health care concern, and is estimated to affect 20% of individuals worldwide (1). In addition to the costs of medical treatment, loss of wages and productivity are among the many indirect costs incurred owing to chronic pain (2).

Chronic pain can arise from injury, surgery, musculoskeletal conditions, or cancer and may result in mobility issues and mood changes (3, 4). Complications from diabetes, arthritis, and stroke are other common causes of chronic pain, particularly among the elderly (5). The physical impediments caused by chronic pain can lead to difficulties at work and affect an individual’s ability to maintain strong social connections (4).

Alleviating Chronic Pain

Proper techniques for pain management ought to control pain and allow individuals to complete their daily activities (4). While medication is an integral component of managing chronic pain, other strategies such as exercise therapy also play a role in the long-term management of chronic conditions (3).

A large body of scientific evidence has demonstrated the benefits of long-term exercise on chronic low back pain (6, 7), chronic neck pain (8), and neuropathic pain (9, 10). Additionally, exercise improves physical function as well as mood. It also prevents cardiovascular, neurodegenerative, and bone diseases that may further exacerbate pain (1).

Exercises that stabilize the spine and strengthen the core can build strength and endurance in muscle groups that support the back. This helps manage chronic low back pain. This is particularly important since atrophy and other structural changes are often seen in these muscle groups, resulting in weaker muscles that are more prone to fatigue (11).

Digital Health Platforms for Chronic Pain Management

Digital tools can help patients progress beyond the early stages of exercise training to establish positive habits. It can also help with understanding patient perceptions of pain to inform more effective pain management therapies.

1.    Using virtual coaches for exercise therapy

Maintaining high patient engagement is especially critical during the initial stages of exercise training when patients may experience a short-term exacerbation of pain (12). Without close supervision, patients are unlikely to complete programs, resulting in sedentary lifestyles that perpetuate the vicious cycle of escalating pain (1). Since direct supervision by a health care professional for a patient’s pain is not always possible, digital platforms prove very useful for remote monitoring and training.

Digital health platforms provide the necessary guidance for patients to follow exercise regimens. They can play the role of a virtual coach to increase patient engagement. Virtual coaches interact with patients, gamify the exercise schedule, and ensure that patients complete exercises correctly. Further, access to demonstration videos for exercises can help patients follow their health care provider’s instructions, preventing injuries caused by poor form.

2.    Using digital diaries to track pain

One of the most difficult aspects of effective pain management is the accurate baseline assessment of patients. These assessments consist of physical examinations and self-reported pain ratings (4). However, during a doctor’s appointment, patients often find it difficult to remember and report how they felt over an extended period of time.

Digital diaries allow patients to log their symptoms and pinpoint the start and end dates of experiencing pain. These diaries serve as an accurate record to guide the development of a personalized treatment plan (13).

3.    Using digital tools for goal setting

Digital tools can be used to set timelines to fulfil specific goals in a pain management plan. These facilitate more accurate monitoring of patient progress and build rapport between patients and clinicians. Such digital tools also promote active engagement with patients by issuing real-time feedback, visualizing progress and achievements, and encouraging patients to modify their coping strategies based on how they feel on a daily basis.

References

1.    Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, et al.  Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions. J Pain. 2019 Nov; 20(11): 1249-1266.

2.    He D, Botta M, Kumar A. Low back pain: Two insights on treatment patterns from a patient journey analysis [Internet]. McKinsey & Company; 2017 Nov 1 [cited 21 Dec 2021]. Available from: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/low-back-pain-two-insights-on-treatment-patterns-from-a-patient-journey-analysis

3.    Healthdirect. Chronic pain [Internet]. Healthdirect; 2021 Jan [cited 28 Dec 2021]. Available from: https://www.healthdirect.gov.au/chronic-pain

4.    New South Wales Government Health. Chronic pain management [Internet]. 2021 Mar 23 [cited 21 Dec 2021]. Available from: https://www.health.nsw.gov.au/pharmaceutical/doctors/Pages/chronic-pain-medical-practitioners.aspx

5.    Schwan J, Sclafani J, Tawfik VL. Chronic Pain Management in the Elderly. Anesthesiol Clin. 2019 Sep; 37(3): 547-560.

6.    Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005 Jul 20; Issue 3: Article no. CD000335.

7.    van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol. 2010 Apr; 24(2): 193-204.

8.    Gross AR, Paquin JP, Dupont G, Blanchette S, Lalonde P, Cristie T, et al. Exercises for mechanical neck disorders: A Cochrane review update. Man Ther. 2016 Aug; 24: 25-45.

9.    Boldt I, Eriks-Hoogland I, Brinkhof MW, de Bie R, Joggi D, von Elm E. Non-pharmacological interventions for chronic pain in people with spinal cord injury. Cochrane Database Syst Rev. 2014 Nov 28; Issue 11: Article no. CD009177.

10. Dixit S, Maiya A, Shastry B. Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, randomized controlled trial. Qual Life Res. 2014 Jun; 23(5):1629-1640.

11. Suh JH, Kim H, Jung GP, Ko JY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine (Baltimore). 2019 Jun; 98(26): Article no. e16173.

12. Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther. 2010 Jun; 15(3): 220-228.

13. Asar A. How AI and Technology Can Help Patients Manage Chronic Pain [Internet]. Forbes; 2020 Sep 25 [cited 21 Dec 2021]. Available from: https://www.forbes.com/sites/forbestechcouncil/2020/09/25/how-ai-and-technology-can-help-patients-manage-chronic-pain/?sh=1caf5e124489

14. Ledel Solem IK, Varsi C, Eide H, Kristjansdottir OB, Mirkovic J, Børøsund E, et al. Patients’ Needs and Requirements for eHealth Pain Management Interventions: Qualitative Study. J Med Internet Res 2019; 21(4): Article no. e13205

15. Bostrøm K, Børøsund E, Varsi C, Eide H, Flakk Nordang E, Schreurs KM, et al. Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study. JMIR Form Res. 2020 Oct 23; 4(10): Article no. e23893.