Rohaj Aarushi, Bulaj Grzegorz
The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA.
Department of Medicinal Chemistry, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA.
Healthcare (Basel). 2023 May 18;11(10):1469. doi: 10.3390/healthcare11101469.
Digital therapeutics (DTx, software as a medical device) provide personalized treatments for chronic diseases and expand precision medicine beyond pharmacogenomics-based pharmacotherapies. In this perspective article, we describe how DTx for chronic low back pain (CLBP) can be integrated with pharmaceutical drugs (e.g., NSAIDs, opioids), physical therapy (PT), cognitive behavioral therapy (CBT), and patient empowerment. An example of an FDA-authorized DTx for CLBP is RelieVRx, a prescription virtual reality (VR) app that reduces pain severity as an adjunct treatment for moderate to severe low back pain. RelieVRx is an immersive VR system that delivers at-home pain management modalities, including relaxation, self-awareness, pain distraction, guided breathing, and patient education. The mechanism of action of DTx is aligned with recommendations from the American College of Physicians to use non-pharmacological modalities as the first-line therapy for CLBP. Herein, we discuss how DTx can provide multimodal therapy options integrating conventional treatments with exposome-responsive, just-in-time adaptive interventions (JITAI). Given the flexibility of software-based therapies to accommodate diverse digital content, we also suggest that music-induced analgesia can increase the clinical effectiveness of digital interventions for chronic pain. DTx offers opportunities to simultaneously address the chronic pain crisis and opioid epidemic while supporting patients and healthcare providers to improve therapy outcomes.
数字疗法（DTx，即软件作为医疗设备）为慢性病提供个性化治疗，并将精准医疗扩展到基于药物基因组学的药物治疗之外。在这篇观点文章中，我们描述了用于慢性下腰痛（CLBP）的数字疗法如何与药物（如非甾体抗炎药、阿片类药物）、物理治疗（PT）、认知行为疗法（CBT）以及患者赋权相结合。美国食品药品监督管理局（FDA）批准的一种用于CLBP的数字疗法示例是RelieVRx，这是一款处方虚拟现实（VR）应用程序，作为中重度下腰痛的辅助治疗手段可减轻疼痛严重程度。RelieVRx是一个沉浸式VR系统，提供居家疼痛管理模式，包括放松、自我意识、疼痛分散注意力、引导呼吸以及患者教育。数字疗法的作用机制与美国医师学会关于将非药物模式作为CLBP一线治疗方法的建议一致。在此，我们讨论数字疗法如何能够提供多模式治疗选择，将传统治疗与暴露组反应性即时自适应干预（JITAI）相结合。鉴于基于软件的疗法具有灵活容纳各种数字内容的特性，我们还建议音乐诱导镇痛可以提高数字干预对慢性疼痛的临床疗效。数字疗法为同时应对慢性疼痛危机和阿片类药物流行提供了机会，同时支持患者和医疗保健提供者改善治疗效果。
