Mobile Apps for Postoperative Pain Management

January 31, 2020

In the age of the Internet and other types of innovative technology, digital health care solutions are becoming widespread.1 These solutions include electronic health records, self-service kiosks in health centers, wearable technologies, wireless communication and more.2 In particular, health and wellness-related applications help users with matters ranging from heart rate monitoring to yoga and meditation.3 Anesthesiology professionals can use such mobile applications to help patients throughout the perioperative period. Recent research has approached the use of mobile apps for pain management,4 particularly in the postoperative phase. In order to integrate these apps into their practices, anesthesia providers should be aware of the types and features of available apps, as well as their efficacy for postoperative pain management.

Mobile apps have mechanisms for pain management that can reduce health care costs, lower complication rates and increase patient and clinician satisfaction.5 For example, Dunsmuir et al.’s “Panda” app for postoperative pain management supports parents in assessing their children’s pain, scheduling medication reminders using alters and tracking medications administered and pain histories.6 The Panda app includes four pediatric self-report pain scales that require children to use the app to indicate their pain level.6 Some apps assess measures such as momentary pain and pain’s interference with the patient’s social life, sleep and general activities.4 Armstrong et al.’s study of a mobile app for follow-up care in breast reconstruction patients had patients record their quality of recovery, pain, surgery-specific questions and daily surgical site photos.5 In a study of postoperative monitoring after ambulatory lumbar discectomy, Debono et al. used an app that allowed patients to alert their providers for fever, optimization of analgesics, dressing problems and more.7 These mobile apps may allow patients to communicate with their clinicians in an efficient manner, reducing the number of phone calls for postoperative recovery-related questions.5 They also allow the anesthesia provider and other clinicians to make real-time assessments of pain, analgesic medication needs and surgical site infections.

As mobile apps for postoperative care and pain management become more common, several researchers have begun to assess their efficacy. In a study by Abelson et al., participants identified numerous benefits of mobile health technology apps for postoperative care, including better monitoring, improved communication with their clinicians, fewer follow-up visits, more convenience and increased patient knowledge.8 Meanwhile, Semple et al.’s study showed that a mobile app for patients recovering from breast reconstruction or orthopedic surgery was feasible and acceptable to patients and clinicians alike.9 Patients were satisfied with the mobile app and used it consistently, and surgeons liked its design, portability and time efficiency.9 In Debono et al.’s study, patients were satisfied with the app and the need for in-person visits was minimized.7 Additionally, Dunsmuir et al.’s Panda app was a feasible support system for parents to manage their children’s pain after discharge from the hospital.6 This could contribute to prevention of excess pain and readmission.6 However, there remain many issues with apps for postoperative pain management. For one, a review by Lalloo et al. found that currently available apps for postoperative pain lack evidence-based content and goal-setting or social support functions.10 Pain management apps in general face issues with clinician and patient involvement, user interface and security.11 Also, some patients may be less willing to engage with mobile apps than others.12 This hesitation could be due to technological issues, concerns about security of personal health information, preference for face-to-face interaction and required effort level.8 Evidently, mobile health apps may help with postoperative pain management, but they are not a panacea.

Digital health care solutions are becoming commonplace in all fields, including postoperative care and pain management. Mobile health apps allow patients to communicate with their clinicians about pain, fever, wound infection and other concerns. Though some mobile health apps have shown success in postoperative pain management, several technological and preferential barriers stand in the way of universal use. Future research should emphasize the anesthesia provider’s role in app-based postoperative pain management. Additionally, developers should find tools and features that make postoperative pain management apps more appealing and effective.

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4.         Thurnheer SE, Gravestock I, Pichierri G, Steurer J, Burgstaller JM. Benefits of Mobile Apps in Pain Management: Systematic Review. JMIR mHealth and uHealth. 2018;6(10):e11231.

5.         Armstrong KA, Coyte PC, Bhatia RS, Semple JL. The Effect of Mobile App Home Monitoring on Number of In-Person Visits Following Ambulatory Surgery: Protocol for a Randomized Controlled Trial. JMIR Research Protocols. 2015;4(2):e65.

6.         Dunsmuir D, Wu H, Sun T, et al. A Postoperative Pain Management Mobile App (Panda) for Children at Home After Discharge: Usability and Feasibility. JMIR Perioperative Medicine. 2019;2(2):e12305.

7.         Debono B, Bousquet P, Sabatier P, Plas J-Y, Lescure J-P, Hamel O. Postoperative monitoring with a mobile application after ambulatory lumbar discectomy: An effective tool for spine surgeons. European Spine Journal. 2016;25(11):3536–3542.

8.         Abelson JS, Kaufman E, Symer M, Peters A, Charlson M, Yeo H. Barriers and benefits to using mobile health technology after operation: A qualitative study. Surgery. 2017;162(3):605–611.

9.         Semple JL, Sharpe S, Murnaghan ML, Theodoropoulos J, Metcalfe KA. Using a Mobile App for Monitoring Post-Operative Quality of Recovery of Patients at Home: A Feasibility Study. JMIR mHealth and uHealth. 2015;3(1):e18.

10.       Lalloo C, Shah U, Birnie KA, et al. Commercially Available Smartphone Apps to Support Postoperative Pain Self-Management: Scoping Review. JMIR mHealth and uHealth. 2017;5(10):e162.

11.       Zhao P, Yoo I, Lancey R, Varghese E. Mobile applications for pain management: An app analysis for clinical usage. BMC Medical Informatics and Decision Making. 2019;19(1):106.

12.       Abelson JS, Symer M, Peters A, Charlson M, Yeo H. Mobile health apps and recovery after surgery: What are patients willing to do? The American Journal of Surgery. 2017;214(4):616–622.