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Digital Therapeutics in the Management of Chronic Pain

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Handbook of Pain and Palliative Care

Abstract

Digital therapeutics are a much-needed addition to the available treatments necessary to curb today’s chronic pain epidemic. Having evolved in the past several years and now being clinically validated and able to readily connect to clinical dashboards, these treatments represent an alternative option to help patients and clinicians alike address chronic pain and its most common comorbidities. This chapter provides a broad overview of digital therapeutics, a discussion of several types of digital treatments available, and a detailed review of clinical data demonstrating the promise and potential of digital therapeutics that address the interpretation of pain via a neural systems approach.

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Notes

  1. 1.

    http://peartherapeutics.com/wp-content/uploads/2017/09/Pear-letterhead-FDA-Clearance-FINAL-FINAL-9.14.17.pdf

  2. 2.

    https://www.fda.gov/MedicalDevices/DigitalHealth/DigitalHealthPreCertProgram/default.htm , https://www.fda.gov/downloads/MedicalDevices/DigitalHealth/UCM568735.pdf

  3. 3.

    https://www.gov.uk/government/organisations/accelerated-access-review/about

  4. 4.

    Contingency management (CM) uses stimulus control and positive reinforcement to change behavior. Most common practices use voucher-based rewards or randomized prize incentives. There has been a good deal of research done on CM programs at UCONN Health (https://health.uconn.edu/contingency-management/) and new research coming out of MIT showcases the opportunities around layering social constructs over CM systems in an approach termed “Social Physics” by researchers, including Sandy (Alex) Pentland, PhD of the Connections Initiatives at MIT (http://connection.mitedu).

  5. 5.

    Wearables and IoT are often used interchangeably and together refer to the numerous small connected devices that are prevalent today and growing in popularity such as fitness trackers, smart watches, and new more targeted health collection devices such as digital scales, blood pressure cuffs, and heart rate monitors.

  6. 6.

    Note that the authors are engaged in the development and clinical trials of digital therapeutics that include an ACT element.

  7. 7.

    Resonant breathing is breathing that activates the coordinated function of oscillating body systems. This breathing increases your heart rate variability. Heart rate variability is a measure of the continuous interplay of your sympathetic (stress response) and parasympathetic (relaxation response) nervous systems and offers information about the flexibility of your autonomic nervous system. This, in turn, reveals the capacity to which you are able to regulate your emotional responses and the degree to which your cardiac activity can be modulated to meet the demands of changing situations.

  8. 8.

    Positive trials are those in which the complementary approach provided statistically significant improvements in pain severity or pain-related disability or function compared with the control group. Negative trials are those in which no difference was seen between groups.

  9. 9.

    While augmented reality (AR) – the projection of realistic 3-D images overlaid on the real world via a smart device or special glasses – offers another exciting opportunity for patient treatment, this technology has largely been used in medical education and training for clinicians rather than patient engagement, and to date there are very limited applications using AR for treatment.

  10. 10.

    Cahana A, 2018, https://medium.com/crypto-oracle/how-blockchain-will-help-fix-the-opioid-and-healthcare-crisis-part-2-d90c11347af9

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Author information

Authors and Affiliations

  1. Transmedia, San Francisco, CA, USA

    Beth Rogozinski

  2. Stanford University, Portola Valley, CA, USA

    Walter Greenleaf PhD

  3. AppliedVR, Studio City, CA, USA

    Josh Sackman

  4. Ark-Invest, New York, NY, USA

    Alex Cahana MD

Authors
  1. Beth Rogozinski
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  2. Walter Greenleaf PhD
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  3. Josh Sackman
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  4. Alex Cahana MD
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Corresponding author

Correspondence to Beth Rogozinski .

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Editors and Affiliations

  1. Bethesda, MD, USA

    Rhonda J. Moore

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Rogozinski, B., Greenleaf, W., Sackman, J., Cahana, A. (2018). Digital Therapeutics in the Management of Chronic Pain. In: Moore, R. (eds) Handbook of Pain and Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-95369-4_30

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