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Using Digital Technology to Improve the Outlook for Chronic Low Back Pain

October 8, 2020
As seen with telemedicine, healthcare is adaptable to change, and patients seem to prefer greater use of technology. New research shows that our mobile devices can help patients with LBP achieve relief and improved quality of life.

Chronic musculoskeletal pain conditions, such as low back pain (LBP), are highly prevalent and costly, not to mention the most common noncancer indication for an opioid prescription in the United States.1 Nonspecific low back pain (NLBP) affects approximately 30% of the world’s population and results in significant direct and indirect health care costs.2 Most cases are thought to be self-limited and that patients will recover with adequate treatment within 2 to 3 months. However, a review of 11 studies showed that only one-third of patients recover within 3 months, and after one year, 65% still report pain.3

NLBP follows a biopsychosocial disease model, and therefore multidisciplinary pain treatment programs comprised of physical, psychological, and educational interventions are recommended by most guidelines.4 These recommendations focus on patients’ ability to actively get better, rather than receiving unnecessary diagnostic procedures, such as spinal and vertebral imaging, pharmaceutical treatment and, perhaps, surgery.

In a telehealth study, a high-risk group of subjects with low back pain who did not receive teleconsultation had greater pain than the other groups at 3 months. (Image: iStock)

Can a Digital App Reduce Care Limitations for Low Back Pain?

In practice, however, most patients do not have access to adequate multidisciplinary treatment, thereby increasing the risk of developing chronic back pain leading to further disease burden and costs.5 Priebe and colleagues, based in Germany, sought to increase the availability of NLBP care using digital health, with an intervention targeted specifically to those at increased risk for the development of chronic back pain.5 It includes four digital elements:

  1. an electronic case report form that could be shared with multiple providers
  2. a treatment algorithm for guideline-based decision making
  3. teleconsultation between the primary care provider and a pain specialist for patients at risk
  4. the multidisciplinary Kaia App for patients to use throughout the treatment period, which includes educational content, physiotherapy, and mindfulness exercises

A total of 1,245 patients were enrolled in the one-year Rise-uP trial, which is currently ongoing. After 3 months, results showed that the Rise-uP digital treatment algorithm was superior to the standard of care that patients in the control group received from their primary care providers.5 Patients in the Rise-uP group showed a 33.3% reduction in pain compared to the 14.3% reduction experienced by those in the control group. The Rise-uP group also showed greater improvements in anxiety, depression, stress, functional ability, and physical and mental well-being. High-risk patients who received a teleconsultation showed an even greater decrease in pain intensity (43.5%).

The Rise-uP trial is based on early identification of those at greater risk for the development of chronic back pain and then providing guideline-oriented treatment.5 The only difference between the Rise-uP protocol and the traditional German guideline used with the control group was the timing of a predictive questionnaire, STarT Back.6 The Rise-uP patients were given the STarT Back questionnaire at the beginning of treatment, and the results were used to predict the patient’s risk for developing chronic back pain. The control group were given the questionnaire only after four weeks of failed treatment, in accordance with the German guideline.

Patients in the Rise-uP group who were deemed high-risk were given a teleconsultation between their primary care providers and a Rise-uP pain specialist. The teleconsultation included a review of the patient’s records, results of questionnaires, determination about further diagnostic evaluation, and discussion about next steps for treatment.

Of the 76 patients who were considered high-risk, 28 received a teleconsultation, while the other 48 did  not. All high-risk patients expressed greater pain at baseline. However, the high-risk group who received a teleconsultation reported pain intensity at 3 months that was equal to that reported by the low risk and the control groups. The high-risk group without the teleconsultation still had greater pain than the other groups at 3 months.

When the investigators looked further for an explanation, they found that the high-risk group who received the teleconsultations used the Kaia App significantly more frequently than those who did not have the teleconsultations. On further analysis, they found that the effect of the teleconsultation on pain improvement was fully mediated by the higher app usage in the high-risk group.

The Kaia app is a multidisciplinary back pain app for use in mobile devices that has shown greater effectiveness in treating patients with lower back pain than physiotherapy in combination with online education.7 These results support those of another large study of more than 10,000 adults that showed a digital care program available through a mobile app resulted in a significant positive relationship between engagement and pain reduction.8

Practical Takeaways

Apps are just one tool being used to provide digital support for health counseling and education. In one systematic review of studies by Stephanie Hewitt, MSc, of North West Boroughs Healthcare NHS Foundation Trust in the United Kingdom, and colleagues, a variety of digital health interventions were found to reduce pain and restore function in patients with musculoskeletal conditions.

Hewitt noted in an email to Practical Pain Management that although it was difficult to draw comparisons between the apps themselves,  digital health interventions have the potential to “contribute positively toward diminishing the personal, societal, and economic impact of musculoskeletal conditions, which, as our population ages, is only set to grow.”9



Last updated on: October 8, 2020
Continue Reading:
Updated NASS Guidelines on Multidisciplinary Low Back Pain Treatment
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