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Remote Pain Management: How It’s Done

About the author: Grant Connelly is the CEO of NeuPath Health, Canada’s leading healthcare provider that delivers category-leading treatment for chronic pain, as well as spinal injuries, sports-related injuries, and concussions, which owns 15 pain clinics in Canada. Grant is a venture-backed, executive-level business professional with over 10 years’ experience in the healthcare industry who has held several CFO positions throughout his career. In July 2018, Grant joined NeuPath as General Manager, and was promoted to Chief Executive Officer just seven months later. Grant was instrumental in the recent acquisition of virtual care platform, KumoCare and virtual reality partnership with Cynergi Health Partners.

Remote pain management is a relatively new concept that has been expedited by the pandemic, particularly because pain was deemed non-urgent and access to in-person treatment was limited. Now, physicians have seen the positive impacts telemedicine can have on patient outcomes. Remote patient monitoring has proven to improve access to care for patients as well as increase the capacity for physicians to treat more patients for conditions like cardiovascular disease and diabetes.

A remote pain management solution combines multidimensional assessment tools, a structured educational pathway, access to virtual coaching, and group interaction. This innovative approach can improve access to care for chronic pain patients across the U.S. while also increasing the capacity for the limited number of board-certified pain care physicians to treat more patients.

In order to understand remote pain management benefits, it’s crucial to unpack how it’s done.

Remote treatment doesn’t need to be a pain in the neck

Many pain physicians ask their patients to rate their pain on a scale from 1-10 every time they visit a clinic. It’s a source of frustration for doctors because they are measuring patient pain when it should be at its highest level – right before their appointment. Not surprisingly, physicians can see very little change in patients’ pain scores from visit to visit, which begs the question: why are you, the patient, continuing to come into clinics for treatment and care if there is no improvement in your pain or condition?

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Patients see the value in in-person treatment, that’s no secret. In-person treatment allows patients to take care of themselves, and regain some of what pain has previously taken from their lives. However, these benefits can be seen through remote pain as well. The problem is that there is a disconnect between patient reported outcomes and the data physicians receive using current techniques.

Multidimensional assessment tools are a big part of the management of other complex chronic illnesses. Similar to diabetes, heart disease, and other chronic conditions, multidimensional assessment tools have a role to play in chronic pain management. A recent study demonstrated that technology, particularly remote tracking or measurement of pain, can be beneficial for managing chronic pain and could even reduce opioid risks.

Measuring pain is not a new challenge. It’s a subjective exercise and pain can be highly influenced by mood, anxiety, sleep, personal relationships, and a number of other factors.

In short: pain is multidimensional. As a result, it’s important to try to measure each of these contributing factors in order to gain a holistic view of the condition and treat the patient, not the condition.

To be clear, the assessment tools available are not new. They are clinically validated tools that look at pain intensity, anxiety and depression, pain-avoidance behavior, pain and sleep, how pain interferes with patient function, and opioid risks. The timing and frequency of when these measurements are conducted – outside of physician visits – and how they are reported back to busy physicians and other health care providers is unique.

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Turning to technology

Mobile phones have become near-ubiquitous, so placing multidimensional assessment tools on an app that lives on a patients’ phone and can be accessed at any time makes sense. Moving beyond paper-based questionnaires completed at physician visits and capturing patient responses between visits should lead to a greater volume of data and, most importantly, more accurate data.

Measurement frequency is a bit of a balancing game between collecting data and not continuously reminding patients about their condition. Research shows that distraction can be an effective pain management tool. Additionally, more than 240 hospitals in the United States are using virtual reality to assist various health-related procedures and help patients visualize and understand their treatment plans. The VR/ AR market in healthcare will reach $5.1 billion by 2025, showcasing a shift in the healthcare industry.

It stands to reason, then, that constantly asking patients about their pain, and reminding patients about their pain, could have the opposite impact. Therefore, a thoughtful approach to determining the frequency for each assessment tool is imperative. While digital tracking and assessment tools significantly aid remote pain management, there’s more to it.

What is Remote Pain Management?

To understand remote pain management, it’s best to look at lived healthcare experiences and what has led clinics to adapt virtual care in the first place.

When we started our remote pain management journey at NeuPath, we conducted a landscape scan. We learned that there are a lot of great technology solutions in the market, including tracking and assessment tools.

We also learned that there was a gap in the market – nobody was offering a complete solution.

Filling the remote gap

As mentioned, there is a gap in the telemedicine and remote pain market and, perhaps more concerning, there is a shortfall in the ability of the healthcare system to meet the growing demand for pain management services. The statistics speak for themself. The fact that the U.S. faces a growing physician shortage should not be a surprise. The shortage for pain specialists is even more acute and the numbers are staggering. It is estimated that there are currently 30,000 chronic pain patients in the U.S. for each board-certified pain care physician.

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Referring each of the 1 in 5 American adults living with chronic pain to a board-certified pain care physician is not an option. At the same time, chronic pain costs between $560 billion to $635 billion per year in the U.S. For perspective, chronic pain is more costly than cardiovascular diseases ($309 billion), neoplasms ($243 billion), injury and poisoning ($205 billion), endocrine, nutritional, and metabolic diseases ($127 billion), and digestive system diseases ($112 billion).

Given the magnitude of the chronic pain problem and its huge societal and economic costs, it’s not a problem that can continue to be ignored. Primary care physicians play a big role in managing care for chronic pain patients, but they are generally ill-equipped from an education perspective. More often than not, these patients are given narcotic painkillers such as Oxycontin, Percocet and Vicodin which can be highly addictive.

Recognizing the need for a biopsychosocial approach to pain management, we at NeuPath began to provide a chronic pain self-management program to our patients. It’s a group-based, psychoeducational course designed to provide patients with education, tools, and confidence to better self-manage their pain.

While the pandemic created a lot of challenges for patients and healthcare providers, one of the silver linings of the pandemic has been greater acceptance of virtual care by both healthcare providers and patients. The pandemic made people recognize the true potential of digital health technologies to cater to the needs of patients, healthcare providers.

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As a result of this shift in attitudes and increased acceptance of virtual care, we started to investigate how we could offer the self-management program to patients virtually. We spoke with patients who participated in the program and facilitators who led the program with a goal of trying to understand our requirements.

There is lots of research supporting the benefits of self-management programs. Based on our findings, patients value interacting with other patients and the opportunity to share with others who understand. Patients also value the program because it provides them with purpose and hope – the feeling that they are finally regaining control over their pain and life. Finally, we found that the facilitators make a big difference – a number of patients participated in our program more than once and reported different outcomes based on the facilitator.

Armed with this information, we returned to our landscape scan and looked outside of the chronic pain world to learn from other successful digital health tools. We found that structured pathways, access to virtual coaching, and fostering the formation of peer groups work well.

So how can physicians use remote pain technologies?

Physicians always prioritize improving patient outcomes, but now more than ever, it is being done through the use of technology. Establishing an effective remote pain technology approach is key and can be tackled using a variety of tools.

Multidimensional assessment tools and succinct easy to understand reporting

These tools facilitate improved communication with healthcare providers and guide patient-centred treatment plans. Data and trends can also be helpful for patients trying to understand triggers for flare ups. The goal is to take a biopsychosocial approach to providing patients with education, confidence, and the tools needed to better self-manage chronic pain.

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Structured educational pathway and self-management tools

A structured educational pathway provides patients with purpose and hope, particularly around regaining control of their lives and their condition. Motivation and rewards are also important to drive stickiness and continued engagement.

Virtual coaching

A recent study showed statistically and clinically significant improvements in pain intensity and pain-related interference for patients participating in a telephonic health and wellness coaching program. Virtual coaches mimic facilitators seen through in-person chronic pain self-management programs and provide additional motivation/accountability for patients utilizing remote pain management technology.

Group formation and communication

Chronic pain can be very isolating and these types of patients report benefits from interacting with other patients and having an opportunity to share with others who understand their condition and journey. Patients can also derive additional benefits from participating in a group, particularly around motivation and continued engagement with the technology.

Putting remote pain management into practice

Needless to say, providing chronic pain management education to the 209,000 practicing primary care physicians in the U.S. is a daunting task and not one that can be completed overnight.

Technology-based solutions, like remote pain management technology, should play a big role in helping to reduce the huge societal and economic impacts of chronic pain, not to mention improving quality of life for people living with chronic pain and their friends and family.

Technology should not be viewed as a replacement for physicians, but as a supplement to their work. A well-executed remote pain management solution can allow for varying degrees of self-management and would also allow for improved communication with other health care providers, including: physiotherapists, mental health professionals, and primary care physicians.

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