An Innovative, Information and Communication Technology Supported Approach, Towards Effective Chronic Pain Management

Introduction

Chronic pain is one of the most common health problems world­wide (Elliott et al., 1999) and a common cause for patients consulting a doctor (Breivik et al., 2005; Eriksen et al., 2003). Pain is defined as being chronic or long-term when it lasts for longer than 3 to 6 months, or beyond the normal healing time of an injury. Classifying pain is helpful to guide assessment and treatment whereas, there are many ways to classify pain and classifications may overlap (International Association for the Study of Pain, 2011). People with chronic pain often experience high levels of disability (Blyth et al., 2003) and are adversely affected on areas including daily activity, employment, relationships, and emotional functioning (Breivik et al., 2005). Impairment due to chronic pain leads to high levels of work absence and dramatically increases health care needs. In addition, pain imposes a huge financial and psychosocial burden on patients, their families and society (Andersson, 2009; Gore et al. 2012; Gustavsson at al. 2012; Nitter, 2013; Waddell & Nordlund 2000). According to (Elliott et al., 1999) patients suffering from chronic nonmalignant pain constitute a heterogeneous population in terms of clinical presentation and treatment results.

Chronic pain is associated with many different diagnostic entities ranging from diseases like, e.g. osteoarthritis, low-back pain and other musculoskeletal conditions to neuropathic pain conditions like painful diabetic polyneuropathy and pain following a stroke or multiple sclerosis. Due to this, treatment also varies from patient to patient and may include pharmacological treatments, neuromodulation, physiotherapy, multimodal rehabilitation. According to (Kroenke et al. 2009) pain and depression are the most common physical and psychological symptoms in primary care. Parallel assessment and treatment of psychiatric comorbidities and sleep disorders combined with traditional rehabilitation, i.e. physical activation and cognitive reorganization are imperative for improved outcomes.

Pain management is one of the most neglected aspects of health care. Chronic pain management is often limited. Pain specialists are able to manage very few patients, while almost half of the patients with chronic pain receive inadequate pain management. Failure to adequately address chronic pain is a major driver of its economic and social burden. Inappropriate and ineffective management and treatment generate repetitive visits to primary care physicians and referrals to specialists. The International Association for the Study of Pain (https://www.iasp-pain.org/) has identified significant problems with waiting times and access to pain services, issues that often result in significant deterioration of patient’s health. Evidence suggests that patients should receive treatment as soon as possible, to avoid deterioration in the quality of life, psychological well-being and depression. Clinicians need to work with patients to establish the best course of treatment. Enhancement of communication between clinicians and patients is one of the most important elements to establish an optimal pain treatment and quality pain self-management support. Improvement of chronic pain management in a large patient population, with limited resources, requires the development of tools for self-management, therapeutic control, and documentation of effects (Phillips, 2000). Such tools can encourage patients in taking an active involvement in their treatment while facilitating care providers to assist patients in a cost-effective manner.