Digital health is disrupting traditional medical practices and reshaping the future of medicine. With the successful implementation of technology into healthcare environments, assessing patient outcomes has become a ‘painless’ process, free of errors and delays.
Electronic pain surveys, in particular, have numerous advantages over standard questionnaires and pen-and-pencil methods, including the optimal assessment of pain severity, the multiple domains of pain, and any pathophysiological mechanisms underlying the perception of pain.
- Online pain measurements can help health practitioners collect information fast. In fact, analyses show that the response time is approximately two-thirds shorter than that of traditional methods. Since delays can sabotage research as well as practice, these figures shouldn’t be underestimated in practice.
- Digital pain methods are not only fast but accurate. Since information is collected automatically, results are accurate and free of human error. In addition, researchers have revealed that digital tests lead to more honest and detailed answers.
- Electronic pain surveys are flexible. In fact, people can skip irrelevant questions or choose a time that suits their daily activities, which makes digital surveys more attractive to participants. This is a major factor to consider because patient recruitment can become a challenging task.
- Digital pain measures help scientists target any population of interest easily and analyze information fast, which makes e-surveys cost-effective.
- Online pain measures, just like any electronic forms, answer the demands of today’s digital health market – simply because research focuses solely on patients and their well-being.
Pain Assessment and Chronic Pain
From childbirth to injuries, pain plays a vital role in people’s reproduction and survival. Nevertheless, pain – being one of the most common medical concerns worldwide – requires effective pain management practices. The assessment of chronic pain, in particular, is essential in healthcare. According to data, only in the US, chronic pain (which is defined as any pain lasting over 12 weeks) affects 30% of adults. Note that pain-related symptoms cause not only physical and/or emotional distress but lead to financial problems which affect the whole of society. In fact, in the US, the costs of chronic pain reach $550-625 billion per year (Dansie & Turk, 2013). Sadly, some individuals do not have access to adequate care due to financial reasons.
With all the physical, emotional, and social factors involved in pain assessment and management, it’s no surprise that assessing pain symptoms is a complex process. It includes the assessment of self-reported symptoms, laboratory tests, and psychological factors. Precise measures are essential for the accurate classification of chronic conditions and the effective treatment of illnesses (Fillingim et al., 2016). Therefore, pain assessment methods tackle multiple health outcomes, including interviews, repeated assessments, and standardized measures (e.g., McGill Pain Questionnaire and PROMIS pain interference and pain behaviors item bank). Common digital pain assessments tackle:
- Sensory and affective qualities of perceived pain: Pain is a relative concept which depends on numerous factors, such as pain duration and emotional support. Since pain is a subjective experience, self-reports are the gold standard to measure and manage chronic pain. When it comes to self-reports which address the sensory and the affective qualities of perceived pain, experts can utilize different scales: categorical scales (e.g., ‘severe,’ ‘mild’), numerical rating scales, visual analog scales or standardized verbal descriptor scales. The Faces Pain Scale, on the other, can be beneficial in pediatric populations.
- Pain intensity and duration: Assessing the pain intensity over a certain period as well as its duration is vital. While acute pain might be unbearable, chronic pain may affect not only a patient’s physical health but emotional well-being. In fact, patients with chronic pain are at a higher risk of experiencing anxiety and depression. Note that the assessment of pain intensity and duration may include retrospective self-reports, which are designed to track and assess the full history of the patient.
- Pain location: As pain sensations can spread across the whole body, measuring pain location (via pain drawing, for instance) is also essential. Pain location methods are used to illustrate how chronic pain affects other parts of the body or certain bodily functions. Pain drawing methods, in particular, are effective and inexpensive techniques used to report pain location.
PROMIS & Pain Assessments
Embracing the future of digital health and focusing on patients’ well-being, the Patient-Reported Outcomes Measurement Information System (PROMIS) is one of the most effective methods used to assess pain-related symptoms. The PROMIS base has implemented numerous e-surveys to improve pain assessment. Statistically valid, reliable, and easy to use, any PROMIS tools can improve patient outcomes. This is vital as patients are the center of today’s digital health, and clinicians must be aware of their emotional well-being and medical decisions. As a matter of fact, a study showed that PROM measures could actually help physicians understand patients better and improve pain management practices (Adam et al., 2016). PROMIS surveys are tailored towards individual patients, which is usually based on their answers to previous items. PROMIS measures have numerous advantages over standard pain assessments. They also offer multiple e-formats, adaptations, and translations.
The PROMIS pain-related domains and the PROMIS pain interference and pain behaviors item bank, in particular, is revolutionary. Tests include diverse aspects and scales (e.g., pain intensity, interference, behavior, and quality) to help clinicians assess pain and improve pain management practices:
- Pain intensity: Since pain is a subjective experience, pain intensity and severity become a major factor in pain assessment. The PROMIS measurements include 0-10 scales to assess pain intensity as well as pain severity.
- Pain interference: Pain interference is vital to assess the degree to which chronic pain affects other activities. Some patients may experience extreme levels of anxiety and frustration due to the physical challenges they struggle with, which can lead to social isolation and depression.
- Pain behavior: Pain behavior is an important aspect that indicates a patient might be experiencing pain (e.g., complaints, facial expressions, etc.). Note that the original PROMIS pain behavior item survey includes 39 items to assess pain-related factors, such as movement, social interactions, expressions, and affect.
- Pain quality: There’s a wide range of pain-related symptoms. Analyses showed six distinctive qualities: numbness, pulling pain, sharp pain, pulsing pain, dull pain, and affective pain, which can help people describe pain (Revicki & Cook, 2015).
Digital Pain Measures and Pain Management
From stabbing pain to dull sensations, pain perception varies between people. Since pain assessment is a multidimensional concept, numerous surveys have been designed to understand chronic pain. As mentioned above, since digital surveys have numerous benefits over standard methods, more and more tests have e-adaptations. It’s no surprise that many pain assessment tools have electronic versions – technological advancements can facilitate research and improve health practices worldwide. With the rapid advancements in the field of digital health, electronic measures, such as PROMIS, have become more and more popular.:
- E-surveys and wearables are accurate, attractive, and inexpensive. Data can be collected and assessed in real time, 24/7.
- Apps, in addition, are ideal for mobile devices and the daily assessment of pain across multiple domains (e.g., sensory, affective, and cognitive). What’s more, as mobile devices are an integrated part of people’s lives, apps can offer an interactive and engaging interface and tasks on a daily basis.
- With their sophisticated functions, impressive storage capability options, and numerous notifications, mobile phones can help patients plan different action steps toward better pain management.
- By relying on virtual communication rather than actual clinical visits, patients spare valuable time from standard invasive methods. This, in fact, is one of the major benefits of telehealth, which makes digital pain surveys essential for the daily collection of pain ratings and pain management practices.
In fact, a study conducted by Pombo and colleagues revealed that tech-based tools are fundamental in pain management practices. To be more precise, the team reviewed all English-language literature published since 2000 and included 62 studies which involved the use of mobile systems and web-based systems. Based on data collected from 13,338, Pombo and colleagues revealed that e-surveys are well-accepted, and data is highly reliable (Pombo, 2016). While paper diaries are prone to backfilling, and phone calls are way too time-consuming and invasive, e-surveys provide accurate measures in real time. We should mention that another study conducted by Ranney and colleagues showed that 89.5% of participants (especially females and those under 50) are more likely to use digital health surveys and reported better pain coping skills (Ranney, 2016). Pain coping skills are fundamental in rare and life-threatening diseases. Note that 30% of reduction of pain symptoms is considered as a significant patient outcome.
Digital Pain Surveys and Popular Pain Assessments
Although digital pain surveys – with their numerous benefits over standard pain assessment methods – are the future of medicine, pain assessment is still a complicated process. In fact, pain assessment has been troubling scientists for a long time, and as a result, numerous pain scales and approaches have been developed. Here we should mention that one of the most popular scales used for pain assessment is the McGill Pain Questionnaire, which is a three-part assessment tool. Note that the McGill survey includes different classes of word descriptors to describe pain experience and its psychological effects on people (Lazaridou et al., 2018). Another popular tool used to measure pain is the Brief Pain Inventory Short Form, which contains 17 items to measure the sensory intensity and the degree to which pain affects patients’ lives.
Comprehensive methods are also needed along with short forms. The West Haven-Yale Multidimensional Pain Inventory is a comprehensive measure, which includes 52 items with 12 subscales which assess multiple social aspects. One of the longest scales is the Treatment Outcomes of Pain Survey, which, in fact, is an extension of the Medical Outcomes Study 36-Item Short-Form Health Survey. Note that its 120 items tackle multiple factors, such as pain management, fear, avoidance, and even addictive behavior (Younger et al., 2009).
Digital Pain Surveys: Conclusion
Pain is one of the major health concerns among patients and practitioners. Chronic pain, in particular, has numerous physical and emotional adverse health effects. From depression to negative automatic thoughts, chronic pain affects not only patients but families and societies. Thus, pain assessment is crucial in medical settings to help experts analyze pain-related symptoms and improve pain management practices. Although there’s a wide variety of methods which assess different pain-related aspects (e.g., emotional problems and pain severity), digital pain surveys are the most popular method in medical settings.
Research shows that digital pain surveys, such as PROMIS, can improve pain assessment. To be more precise, online pain measures help experts collect information fast and analyze data in real time. Digital surveys provide accurate and reliable information and offer a personalized approach to pain management. Most of all, with all the abundance of apps and reminders, e-surveys can engage participants and help them improve their own well-being.
To sum up, digital pain assessments help experts assess pain ‘painlessly’ and achieve better patient-reported outcomes.
Adam, R., Burton, C., Bond, C., Bruin, M., & Murchie, P. (2016). Can patient-reported measurements of pain be used to improve cancer pain management? A systematic review and meta-analysis. BMJ Supportive and Palliative Care, 7 (4).
Dansie, E., & Turk, D. (2013). Assessment of patients with chronic pain. British Journal of Anesthesia, 111 (1), p. 19-25.
Fillingim, R., Loeser, J., Baron, R., & Edwards, R. (2016). Assessment of Chronic Pain: Domains, Methods, and Mechanisms. The Journal of Pain, 17 (9).
Lazaridou, A., Elbaridi, N., Edwards, R., & Berde, C. (2018). Pain assessment. Essentials of Pain Medicine. Retrieved from https://www.sciencedirect.com/science/article/pii/B978032340196800005X
Pombo, N., Garcia, N., Bousson, K., Spinsante, S., & Chorbev, I. (2016). Pain Assessment–Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 13 (4).
Ranney, M., Duarte, C., Baird, J., Patry, E., & Green, T. (2016). Correlation of digital health use and chronic pain coping strategies. Mhealth, 2.
Revicki, D., & Cook, K. (2015). PROMIS Pain-Related Measures: An Overview. Retrieved from https://www.practicalpainmanagement.com/resources/clinical-practice-guidelines/promis-pain-related-measures-overview?page=0,1
Younger, J., McCue, R., & Mackey, S. (2009). Pain Outcomes: A Brief Review of Instruments and Techniques. Current Pain and Headache Reports, 13 (1), p. 39-43.