Marceau Lisa D, Link Carol, Jamison Robert N, Carolan Sarah
New England Research Institutes, Watertown, Massachusetts 02472, USA.
Pain Med. 2007 Oct;8 Suppl 3:S101-9. doi: 10.1111/j.1526-4637.2007.00374.x.
Chronic pain is a common and costly syndrome which affects approximately one in three US adults. Factors such as shortened length of the medical visit, increased availability of technological approaches to care, and a more informed patient all suggest that a new paradigm is required for chronic pain management. Although much has been written about the use of electronic diaries in clinical trials, little has been presented about the use of these diaries in clinic practice and their potential for changing pain behavior. The intent of this preliminary study is to measure accessibility and usability of a software program designed for use on a personal digital assistant and to discuss how the software program may impact clinic practice and patient behavior.
We present the results of a preliminary, randomized, comparison, crossover trial of 36 chronic pain patients who were asked to monitor their pain, mood, activity interference, medication use, and pain location on either a paper or electronic diary for 2 weeks. Patients in the electronic diary condition were able to observe changes in their ratings over time and view them on a secure web site.
No differences were found between paper and electronic tracking on pain descriptors, pain interference, mood, or helpfulness of medication. Similar to past findings, patients found the electronic diary easier to use (P < 0.0001) and would continue using it (P < 0.05) over paper if given the choice. Importantly, patients using the electronic diary reported more frequently that a provider suggested medication change (P < 0.05) based on feedback from the electronic diary. One trend requiring further investigation is that electronic diary users reported that the diary enabled them and their doctor to make care adjustments according to changes in pain status.
This study goes beyond previous research on preference and data quality to investigate how the information provided may affect patient and physician perspectives toward pain management. Although not the initial intent of this study, findings indicate that electronic tracking may provide information which can affect management decisions. A follow-up study is ongoing to investigate these initial results. If found to be true, electronic monitoring may have broad implications for health care, policy, and improvement in quality of care for chronic pain sufferers in the future.
慢性疼痛是一种常见且代价高昂的综合征，约三分之一的美国成年人受其影响。诸如就诊时间缩短、护理技术手段增多以及患者信息更为灵通等因素均表明，慢性疼痛管理需要一种新的模式。尽管关于电子日记在临床试验中的应用已有诸多著述，但关于这些日记在临床实践中的应用及其改变疼痛行为的潜力却鲜有提及。这项初步研究的目的是评估一款设计用于个人数字助理的软件程序的可及性和易用性，并探讨该软件程序可能如何影响临床实践和患者行为。
我们展示了一项针对36名慢性疼痛患者的初步随机对照交叉试验结果，这些患者被要求在纸质或电子日记上记录疼痛、情绪、活动干扰、药物使用及疼痛部位，为期2周。使用电子日记的患者能够观察到自己评分随时间的变化，并在一个安全的网站上查看。
在疼痛描述、疼痛干扰、情绪或药物有效性方面，纸质记录和电子记录之间未发现差异。与过去的研究结果相似，患者认为电子日记更易于使用（P < 0.0001），如果可以选择，他们会继续使用电子日记而非纸质日记（P < 0.05）。重要的是，使用电子日记的患者更频繁地报告称，医生根据电子日记的反馈建议更改药物（P < 0.05）。一个需要进一步研究的趋势是，使用电子日记的患者报告称，日记使他们和医生能够根据疼痛状况的变化进行护理调整。
本研究超越了以往关于偏好和数据质量的研究，旨在探究所提供的信息如何影响患者和医生对疼痛管理的看法。尽管这并非本研究的初衷，但研究结果表明，电子记录可能提供能够影响管理决策的信息。一项后续研究正在进行，以探究这些初步结果。如果情况属实，电子监测可能对未来的医疗保健、政策以及慢性疼痛患者护理质量的改善产生广泛影响。
