Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Institute for Clinical Systems Improvement, Minneapolis, Minnesota.
Pain Med. 2019 Nov 1;20(11):2238-2255. doi: 10.1093/pm/pnz164.
Electronic (eHealth) and mobile (mHealth) technologies may be a useful adjunct to clinicians treating patients with chronic pain. The primary aim of this study was to investigate the effects of eHealth and mHealth interventions that do not require clinician contact or feedback on pain-related outcomes recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) guidelines in adults with chronic pain.
We searched four databases and included English language randomized controlled trials of ambulatory adults with chronic pain from January, 1 2000, to January 31, 2018, with interventions that are independent of clinician contact or feedback. In the meta-analysis, outcomes were assessed at short- (three months or less), intermediate- (four to six months), and long-term (seven or more months) follow-up.
Seventeen randomized controlled trials (N = 2,496) were included in the meta-analysis. Both eHealth and mHealth interventions had a significant effect on pain intensity at short- and intermediate-term follow-up. Similarly, a significant but small effect was observed for depression at short- and intermediate-term follow-up and self-efficacy at short-term follow-up. Finally, a significant effect was observed for pain catastrophizing at short-term follow-up.
eHealth and mHealth interventions had significant effects on multiple short- and intermediate-term outcome measures recommended in the IMMPACT guidelines. Given widespread availability and low cost to patients, clinicians treating patients with chronic pain could consider using eHealth and mHealth interventions as part of a multidisciplinary pain treatment strategy.
电子（eHealth）和移动（mHealth）技术可能是临床医生治疗慢性疼痛患者的有用辅助手段。本研究的主要目的是研究不需要临床医生联系或反馈的 eHealth 和 mHealth 干预措施对慢性疼痛成人中倡议方法、测量和临床试验疼痛评估（IMMPACT）指南推荐的疼痛相关结局的影响。
我们搜索了四个数据库，并纳入了 2000 年 1 月 1 日至 2018 年 1 月 31 日期间接受慢性疼痛的门诊成年人的英语随机对照试验，这些干预措施独立于临床医生的联系或反馈。在荟萃分析中，在短期（三个月或更短）、中期（四到六个月）和长期（七个月或更长）随访时评估结局。
17 项随机对照试验（N=2496）被纳入荟萃分析。eHealth 和 mHealth 干预措施在短期和中期随访时均对疼痛强度有显著影响。同样，在短期和中期随访时对抑郁和自我效能也观察到了显著但较小的影响，而在短期随访时对疼痛灾难化有显著影响。
eHealth 和 mHealth 干预措施对 IMMPACT 指南推荐的多个短期和中期结局测量指标有显著影响。鉴于其广泛的可用性和对患者的低费用，治疗慢性疼痛患者的临床医生可以考虑将 eHealth 和 mHealth 干预措施作为多学科疼痛治疗策略的一部分。
