A patient-controlled, smartphone-based music intervention to reduce pain—A multi-center observational study of patients with chronic pain

A Review of Chronic Pain and Device Interventions: Benefits and Future Directions

Chronic pain is a debilitating condition with a growing prevalence both in the USA and globally. The complex nature of this condition necessitates a multimodal approach to pain management that extends beyond the established pharmaceutical interventions currently employed. A variety of devices comprising both invasive and noninvasive approaches are available to patients, serving as adjuvants to existing regimens. The benefits of these interventions are notable for their lack of addiction potential, potential for patient autonomy regarding self-administration, minimal to no drug interaction, and overall relative safety. However, there remains a need for further research and more robust clinical trials to assess the true efficacy of these interventions and elucidate if there is an underlying physiological mechanism to their benefit in treating chronic pain or if their effect is predominantly placebo in nature. Regardless, the field of device-based intervention and treatment remains an evolving field with much promise for the future chronic pain management.

A web app-based music intervention reduces experimental thermal pain: A randomized trial on preferred versus least-liked music style

Digital technologies are increasingly being used to strengthen national health systems. Music is used as a management technique for pain. The objective of this study is to demonstrate the effects of a web app-based music intervention on pain. The participants were healthy adults and underwent three conditions: Conditioned Pain Modulation (CPM), Most-Liked Music (MLM) and Least-Liked Music (LLM). The music used is MUSIC CARE©, a web app-based personalized musical intervention ("U" Sequence based on a musical composition algorithm). Thermal pain was measured before starting the 20-min music intervention and after three time points for each music condition: 2.20, 11.30, and 20 min. Mean pain perceptions were significantly reduced under both LLM and MLM conditions. Pain decrease was more important under MLM condition than LLM condition at 2.20 min with a mean difference between both conditions of 9.7 (±3.9) (p = 0.0195) and at 11.30 min [9.2 (±3.3), p = 0.0099]. LLM is correlated with CPM but not MLM, suggesting different mechanisms between LLM and MLM. Musical intervention, a simple method of application, fits perfectly into a multidisciplinary global approach and helps to treat the pain and anxiety disorders of participants. Clinical trial registration: [https://clinicaltrials.gov/ct2/show/NCT04862832], ClinicalTrials.gov [NCT04862832].

Smartphone based music intervention in the treatment of episodic migraine headaches - A pilot trial

OBJECTIVES

Migraine headaches are a prevalent and burdening disorder for the public worldwide. Both traditional preventive drugs and behavioral-based interventions have been used as treatment in the prevention of migraine attacks. However, benefits of alternative interventions in patients with primary headache disorders have not yet been fully explored. The present investigation sought to examine the impact of a patient controlled music intervention (MUSIC CARE) on episodic migraine headache.

DESIGN

A sample of 20 episodic migraine patients (17 females, mean age of 42 years) was included in the pilot trial. Patients completed a pre-treatment assessment on headache severity, associated psychopathological distress (anxiety and depression) and functional impairment, and provided reports on their medication intake. During the 3-months intervention period, patients required 1-2 music sessions (based on the "U" sequence) per day with a minimum of 15 per month.

RESULTS

Following the intervention, patients reported a significant reduction in the frequency of migraine attacks (M_Diff = -2.8, p = .01). Ten patients reported a 50% reduction in the frequency of migraine attacks. Additionally, there was a significant reduction in medication intake (M_Diff = -2.85, p = .02), the duration of migraine attacks (M_Diff = -5.45, p = .002), anxiety (M_Diff = -1.65 (2.88), p = .02) and depression (M_Diff = -2.45 (3.5), p = .002).

CONCLUSION

These data provide evidence that music intervention may significantly prevent migraine attacks. Moreover, this method is easily accessible and administered. Future well-controlled clinical trials are necessary to further explore the efficiency of the intervention.

Étude mixte des effets de l’application Music Care sur la souffrance existentielle des patients en soins palliatifs hospitalisés à domicile et de leurs aidants naturels

Cette étude mixte et contrôlée cible les effets de l’application Music Care sur la variable état « souffrance existentielle » de patients hospitalisés à domicile et de leurs aidants naturels, en soins palliatifs, en comparaison avec les effets d’une séance de relaxation. Neuf patients et onze aidants ont été inclus dans la réalisation de cette étude mixte, associant questionnaires et entretiens de recherche. Les résultats quantitatifs démontrent que l’intervention Music Care est significativement plus efficace que la séance de relaxation. La phase qualitative de l’étude met en lumière l’effet ambivalent de cette intervention, empreinte de connotations morbides, mais insufflant du sens à l’expérience de la maladie.

Mobile Application-Based Interventions for Chronic Pain Patients: A Systematic Review and Meta-Analysis of Effectiveness

Chronic pain is one of the major causes of disability in the general population. Even though there are effective treatment options available for reducing symptoms, these treatments often do not have consistent lasting effects. As the usage of mobile devices has increased enormously during the last few years, mobile application-based treatment options are widespread. Such app-based programs are not yet empirically proven but might enable patients to become more independent in their pain management in order to prevent relapse. The aim of this meta-analysis was to summarize the literature on mobile application-based interventions for chronic pain patients. Therefore, three electronic bibliographic databases, PubMed, PsycINFO, and Web of Science, were searched for studies that investigated the effectiveness of mobile application-based intervention for chronic pain on pain intensity. The final sample comprised twenty-two studies, with a total of 4679 individuals. Twelve of these twenty-two studies used a randomized control trial (RCT) design, while ten studies only used an observational design. For all twenty-two studies, a small but significant effect (d = -0.40) was found when compared to baseline measures or control groups. The results suggest that apps-based treatment can be helpful in reducing pain, especially in the long-term.

Efficacy, Treatment Characteristics, and Biopsychological Mechanisms of Music-Listening Interventions in Reducing Pain (MINTREP): Study Protocol of a Three-Armed Pilot Randomized Controlled Trial

Background: Pain can severely compromise a person's overall health and well-being. Music-listening interventions have been shown to alleviate perceived pain and to modulate the body's stress-sensitive systems. Despite the growing evidence of pain- and stress-reducing effects of music-listening interventions from experimental and clinical research, current findings on music-induced analgesia are inconclusive regarding the role of specific treatment characteristics and the biopsychological mechanisms underlying these effects. Objective: The overall aim of this pilot randomized controlled trial is to test and compare the differential effects of frequency-modulated and unmodulated music (both researcher-selected) on experimentally induced perception of acute pain and to test the efficacy of the interventions in reducing biological and subjective stress levels. Moreover, these two interventions will be compared to a third condition, in which participants listen to self-selected unmodulated music. Methods and Analysis: A total of 90 healthy participants will be randomly allocated to one of the three music-listening intervention groups. Each intervention encompasses 10 sessions of music listening in our laboratory. Frequency-modulation will involve stepwise filtering of frequencies in the audible range of 50-4,000 Hz. Acute pain will be induced via the cold pressor test. Primary (i.e., pain tolerance, perceived pain intensity) and secondary (i.e., heart rate variability, electrodermal activity, hair cortisol, subjective stress) outcomes will be measured at baseline, post, and follow-up. In addition, intermittent measurements as well as a follow-up assessment and a range of tertiary measures (e.g., music-induced emotions) are included. Discussion: This is the first study to systematically test and compare the effects of music frequencies along with the control over music selection, both of which qualify as central treatment characteristics of music-listening interventions. Results will be highly informative for the design of subsequent large-scale clinical trials and provide valuable conclusions for the implementation of music-listening interventions for the reduction of perceived pain. Clinical Trial Registration: Clinical Trials Database of the U.S. National Library of Medicine: Identifier NCT02991014.

Benefits of Mobile Apps in Pain Management: Systematic Review

Background

Pain is a common condition with a significant physical, psychosocial, and economic impact. Due to enormous progress in mobile device technology as well as the increase in smartphone ownership in the general population, mobile apps can be used to monitor patients with pain and support them in pain management.

Objective

The aim of this review was to assess the efficacy of smartphone or computer tablet apps in the management of patients with pain.

Methods

In December 2017, a literature search was performed in the following databases: MEDLINE, EMBASE, CINAHL, Cochrane, and PsycINFO. In addition, a bibliography search was conducted. We included studies with at least 20 participants per arm that evaluated the effects of apps on smartphones or computer tablets on improvement in pain.

Results

A total of 15 studies with 1962 patients met the inclusion criteria. Of these, 4 studies examined the effect of mobile apps on pain management in an in-clinic setting and 11 in an out-clinic setting. The majority of the original studies reported beneficial effects of the use of a pain app. Severity of pain decreased in most studies where patients were using an app compared with patients not using an app. Other outcomes, such as worst pain or quality of life showed improvements in patients using an app. Due to heterogeneity between the original studies—patient characteristics, app content, and study setting—a synthesis of the results by statistical methods was not performed.

Conclusions

Apps for pain management may be beneficial for patients, particularly in an out-clinic setting. Studies have shown that pain apps are workable and well liked by patients and health care professionals. There is no doubt that in the near future, mobile technologies will develop further. Medicine could profit from this development as indicated by our results, but there is a need for more scientific inputs. It is desirable to know which elements of apps or additional devices and tools may improve usability and help patients in pain management.