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How online tools can help manage chronic pain

For the one in five Kiwis living with persistent pain, a new self-help tool could hold the key to restoring some quality of life.

Solving the problem of chronic pain isn’t as easy as popping a few pills. As the one in five New Zealanders with persistent pain will tell you, there is no magic cure and it can make life pretty miserable. On top of that, says Hemakumar Devan, a pain researcher and postdoctoral fellow from School of Physiotherapy, University of Otago, Wellington, sufferers often have no obvious signs of impairment, so it is hard for others to understand the extent of their distress.

“Someone can look normal, but the suffering they are going through is huge. And they may have had years of specialist appointments, physiotherapy, osteopathy, acupuncture and taking drugs to try to fix their pain,” says Devan.

Chronic pain is an umbrella term that covers anything from back and neck pain to conditions such as fibromyalgia and post-surgery problems. For sufferers, attending a specialist pain centre seems to be the best approach. There are three – in Auckland, Wellington and Christchurch – where patients are taught strategies to help them manage ongoing symptoms and restore some quality of life. These range from mindfulness and relaxation to a technique called pacing, which can help sufferers stay active while reducing the severity of flare-ups.

Unfortunately, there aren’t enough pain specialists. Waiting lists are long and the number of people with chronic pain is rising as the population ages. Māori, in particular, seem to struggle to access services, despite having the highest rates of chronic pain.

Devan is focusing on how technology might be able to fill the gaps by providing a self-help option for those with persistent pain. He has been assessing the online tools already available. “There are heaps,” he says, “but we narrowed it down from hundreds to a small number that met our criteria.”

He was looking for a smartphone app or website that not only enabled sufferers to track their pain but also offered evidence-based information and strategies to help them manage it. Ideally, peer support and the opportunity to communicate with a clinician would also be part of the package.

Online tools that reached his high standards and criteria were thin on the ground, with only three apps coming close: Curable, PainScale and SuperBetter.

“Most of the apps were focused on different types of mindfulness,” says Devan. “That is one strategy to help people manage pain, but it’s not the only one. So, there is a lot of scope for doing much better.”

Hemakumar Devan. Photo/Supplied

Devan is now involved in a Health Research Council-funded project to create an online self-help tool based on the 12-week pain-management programme offered by Wellington’s Capital & Coast DHB. The idea is that this can be used for ongoing support by patients who have been through a programme or by those still struggling to access one.

“One of the keys of self-management is understanding the mechanisms of chronic pain,” he says. “People often think of it as more of an acute-pain model: rest and recover. But for chronic pain, rest doesn’t work. It makes it worse.”

Developing a digital self-help tool over the past six months has been quite an undertaking. The finished website and app offer a 12-week online module, but also include contributions from graduate patients from the programme who share their experiences of using the strategies. There is a community forum, a health coach and lots of easily digested video, animation and illustrated text.

“So, you pretty much have the programme in your hands and can use it whenever you want,” says Devan.

The other apps he assessed were developed overseas, so particular care has been taken with this one to give it a well-defined New Zealand personality. Māori have been closely involved to make sure they connect with it.

“We’ve incorporated te reo, New Zealand images, the accent, the slang and a Kiwi attitude – everyday stuff people can relate to,” says Devan.

The first group of online patients have started the trial and the plan is to evaluate how they fare in comparison with those who get face-to-face treatment.

“We’re not saying online will be better, but if people can’t get on to a programme, this could be an option while they’re on the waiting list.”

This article was first published in the July 20, 2019 issue of the New Zealand Listener.