N/A
N=215
N-of-1 Trials Using mHealth in Chronic Pain
Musculoskeletal Pain · Chronic Pain
Bottom Line
View on ClinicalTrials.gov: NCT02116621 ↗Enrolled (actual)
215
Serious AEs
0.0%
Results posted
May 2018
Primary outcome: Primary: Change From Baseline in Pain-related Interference on the Patient Reported Outcomes Measurement Information System (PROMIS) Scale at 26 Weeks — -3.22; -1.85 units on a scale
Study Design & Population
- Study type
- Interventional
- Phase
- N/A
- Interventions
- Trialist Intervention (Behavioral); smartphone (Device)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- All
- Sponsor
- University of California, Davis
- Primary completion
- Feb 2017
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Change From Baseline in Pain-related Interference on the Patient Reported Outcomes Measurement Information System (PROMIS) Scale at 26 Weeks |
-3.22; -1.85 | — |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up in Pain-related Interference on the Patient-Reported Outcomes Measurement Information System (PROMIS) Scale |
-2.70; -1.91; -3.22; -1.85; -2.67; -2.83 | 0.21 |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up in Pain Intensity on the Patient-Reported Outcomes Measurement Information System (PROMIS) Scale |
-1.60; -1.92; -2.86; -1.46; -3.00; -1.76 | 0.06 |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up on the Patient-Reported Outcomes Measurement Information System (PROMIS) MENTAL Global Health Scale |
-0.35; 0.30; 0.21; -0.72; 0.36; -0.39 | 0.35 |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up on the Patient-Reported Outcomes Measurement Information System (PROMIS) PHYSICAL Global Health Scale |
0.73; 0.44; 0.13; 0.30; 0.16; 0.42 | 0.86 |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up in Analgesic Adherence (Overuse) on the Pain Medication in Primary Care Patient Questionnaire |
1.40; 0.35; 1.77; -0.13; 1.61; 1.53 | 0.70 |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up in Analgesic Adherence (Underuse) on the Pain Medication in Primary Care Patient Questionnaire |
2.53; -1.71; 1.88; -2.76; -3.53; -1.62 | 0.20 |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up in Patient-provider Relationship on the Trust in Physician Scale |
-2.49; -4.25; -2.30; -4.84; -4.00; -5.53 | 0.66 |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up on the Pain Treatment Satisfaction Scale (PTSS) -Satisfaction With Pain Information |
4.41; -3.36; 11.28; 3.99; 9.02; 4.89 | 0.44 |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up on the Pain Treatment Satisfaction Scale (PTSS) -Satisfaction With Medical Care |
-4.00; -6.15; -2.26; -5.57; -4.52; -5.51 | 0.58 |
| SECONDARY Longitudinal Change From Baseline up to 52 Weeks Follow-up on the Pain Treatment Satisfaction Scale (PTSS) -Satisfaction With Pain Medication |
1.46; -0.34; -0.18; 1.39; 0.77; -0.34 | 0.73 |
Summary
Chronic musculoskeletal pain is an important problem, and treatments are often prescribed in a "trial and error" fashion. Clinicians prescribe a treatment to a patient and then wait and see if the treatment is successful. If the treatment is unsuccessful, they will try a different treatment. The disadvantage to this method is that it may take a long time to find a successful treatment.
The purpose of the PREEMPT Study is to test whether using a mobile phone application ("Trialist app") that allows patients and their health care providers to run personalized experiments comparing two pain treatments is more effective than usual care. Patients download the app, and working with their clinicians, set up a personalized trial that makes sense for them. Every day they answer questions to track levels of pain and side effects of treatment, such as fatigue and constipation. Once the personalized trial has ended, the responses to these daily questions on each treatment will be compared. During a regular clinic visit, the patient and the clinician will review visual displays of the results to facilitate treatment decision-making. Approximately 250 patients will be enrolled in the study. Half the patients will use the app and review results with the clinician, and half the patients will continue with their regular care (i.e., will not use the app). The two groups will be compared to see if using the app is successful in improving long term pain outcomes. The goal of the intervention using the Trialist app is to help patients engage actively and collaboratively with their clinicians and identify effective treatments more quickly.
Eligibility Criteria
Inclusion Criteria
- Chronic musculoskeletal pain (e.g., neck, back, extremities) operationalized as pain present for 6 weeks or more and a pain score of 4 or higher (on a 0-to-10 scale) on at least one of three items from the PEG pain scale
- Age 18-75 years
- Own web-enabled Android or iOS phone with data plan
- In judgment of treating clinician, pain potentially amenable to treatment with acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose opioids, a complementary/alternative treatment such as massage or meditation, or a simple combination of these treatments
- Ability to speak and read English
Exclusion Criteria
- Treated with surgery, radiation or chemotherapy for cancer in past 5 years
- Other medical conditions that in clinician's judgment would limit life expectancy to less than 2 years or imperil patient safety
- Pregnant or breastfeeding
- Dementia, bipolar disorder, schizophrenia, active suicidality
- Current alcohol or prescription drug abuse; history of disruptive behavior
- Failed 5 or more analgesic medications because of lack of effectiveness or poor tolerability
Data sourced from ClinicalTrials.gov (NCT02116621). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.