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“There’s a Pain App for That”: Review of PatientTargeted Smartphone Applications for Pain Management ARTICLE in CLINICAL JOURNAL OF PAIN · NOVEMBER 2014 Impact Factor: 2.7 · DOI: 10.1097/AJP.0000000000000171 · Source: PubMed

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The Clinical Journal of Pain Publish Ahead of Print DOI:10.1097/AJP.0000000000000171

TITLE: “There’s a Pain App for That”: Review of Patient-Targeted Smartphone Applications for Pain Management

AUTHORS: Chitra Lalloo (BHSc, PhD)1,2, Lindsay A. Jibb (BSc, MSc, BScN)2,3, Jordan Rivera (BSc)2, Arnav Agarwal (BHSc)1, Jennifer N. Stinson (RN, PhD, CPNP)2,3,4,5. 1

Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; 2The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada; 3Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; 4Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada; 5Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. CORRESPONDENCE & REPRINTS: Chitra Lalloo Child Health Evaluative Sciences | The Hospital for Sick Children Lawrence S. Bloomberg Faculty of Nursing | University of Toronto The Peter Gilgan Centre for Research and Learning 686 Bay Street, Toronto, ON, M5G 0A4 Email: [email protected] RUNNING TITLE: Review of Smartphone Pain Apps Number of text pages: 19 Number of figures: 1 Number of tables: 1

KEYWORDS: e-Health; smartphone application; pain self-management; critical appraisal; patient-oriented

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STRUCTURED ABSTRACT (248/ 250) Objectives: There are a growing number of pain self-management apps available for users to download on personal smartphones. The purpose of this study was to critically appraise the content and self-management functionality of currently available pain apps. Methods: An electronic search was conducted between May and June 2014 of the official stores for the four major operating systems. Two authors independently identified patient-focused apps with a stated goal of pain management. Discrepancies regarding selection were resolved through discussion with a third party. Metadata from all included apps were abstracted into a standard form. The content and functionality of each app as it pertained to pain self-management was rated. Results: A total of 279 apps met the inclusion criteria. Pain self-care skill support was the most common self-management function (77.4%). Apps also purported providing patients with the ability to engage in pain education (45.9%), self-monitoring (19%), social support (3.6%) and goal-setting (0.72%). No apps were comprehensive in terms of pain self-management, with the majority of apps including only a single self-management function (58.5%). Additionally, only 8.2% of apps included a healthcare professional in their development, not a single app provided a theoretical rationale, and only 1 app underwent scientific evaluation. Discussion: Currently available pain self-management apps for patients are simplistic, lack the involvement of healthcare professionals in their development, and have not been rigorously tested for effectiveness on pain-related health outcomes. There is a need to develop and test theoretically- and evidence-based apps to better support patients with accessible pain care selfmanagement.

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SECTION 1. INTRODUCTION Chronic pain is a common condition with profound negative psychological, social, physical, and economic impacts. Pain self-management interventions providing the ability to monitor the multidimensional experience of chronic pain, develop pain-related knowledge, learn strategies to manage symptoms, and engage in social support are needed to promote optimal health outcomes. Studies in adult 1-4 and pediatric 5-8 chronic illnesses have shown that comprehensive interactive face-to-face psycho-educational interventions lead to symptom reduction and improved health-related quality of life (HRQL) compared with care that is strictly medication focused, with a postulated mechanism being enhanced self-efficacy and empowerment over disease and symptom management.9,10 The content of behavioral treatment programming for pain management often varies between intervention and practitioner, but typically includes several core components that have origins in behavioral change theory.8,11 Common components include: training to support the mastery of self-management skills and the appropriate interpretation of symptoms, as well as social persuasion and access to peer modeling.7,8 Peer support specifically has been shown to be important both theoretically and empirically in a healthcare context.12,13 The importance of peers lies in their ability to provide informational, appraisal, and emotional support based on their common disease experiences, which can result in improved health outcomes.12,14 Selfmanagement programming for chronic conditions, such as pain, therefore often includes a component of peer-based social support.8,15 Evidence supporting self-management treatments in improving pain and pain-related disability in individuals with chronic pain is strong.6-8 Meta-analytical reviews of psychological

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treatments, including cognitive behavioral therapy and coping skills training, for both children and adults have shown promising intervention effectiveness.11,12,17 Still, the integration of these interventions into routine primary and tertiary care has been slow. Thus, the vast majority of patients never receive the requisite comprehensive education or skills training to promote pain self-management and enhance HRQL.18-22 Common barriers to accessing pain-specific education and cognitive-behavioral coping skills training include: (a) poor accessibility related to geography; (b) limited availability of trained professionals; and (c) prohibitive therapy-associated costs.18,20-22 Moreover, existing therapies tend to be delivered in individual or group sessions in specialty clinics by highly trained personnel, and are unsuitable for widespread distribution to community and home-based settings.21,22 Whereas care for chronic pain was once strictly limited to medical environments and clinician-guided telehealth, smartphones can make healthcare accessible in almost any setting.23 Further, smartphone applications (apps) can also help users to take active roles in managing their own condition at their convenience. In real time, apps can help users to access ‗in the moment‘ coping strategies, self-monitor their pain and functioning, set achievable goals related to their chronic pain, and develop a tailored self-management plan based on personalized goals. There are a growing number of pain self-management apps available for users to download and use on their personal mobile devices. In 2011, Rosser and Eccleston identified 111 such apps.24 The majority of apps were designed for the iPhone (iOS) platform, with fewer being available for Android or BlackBerry operating systems. The primary app functions included education skills training (54%), self-monitoring (e.g., pain diary; 24%), and relaxation training

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(22%). Importantly, 86% of the identified apps did not report the involvement of healthcare professionals in their design or evaluation of content.24 Since the Rosser and Eccleston review24, which was conducted between July and August 2010, there has been a significant increase in the number of commercially available apps. In June 2012, Reynoldson and colleagues conducted an updated search of the Apple iTunes (iOS) and Google Play (Android) stores.25 This search only included apps that had the primary function of allowing patients to record their pain episodes (i.e. self-monitoring). Apps were excluded if their intended use was limited to pain from specific conditions, such as arthritis, inflammatory bowel disease, or migraine. The authors identified 12 eligible apps, which then underwent content analysis and usability testing. This review identified a lack of user and clinician engagement in pain app development, as well as variation in clinical content, interface design, and usability.25 To build on this previous research24,25, we conducted an updated scoping review, which aimed to: (1) characterize the current field of patient-focused pain self-management apps across all major smartphone platforms; (2) critically appraise the content and functionality of these apps, including self-care skill support, pain education, self-monitoring, social support, and goalsetting; and (3) identify gaps in the field to guide future pain app development.

SECTION 2. METHODS An electronic search was conducted between May and July 2014 of the official app stores for the four major smartphone operating systems: iOS (iTunes), Android (Google Play), BlackBerry OS (BlackBerry World), and Windows Phone (Windows Store). Entire stores were searched separately for the terms ‗pain‘ and ‗pain management‘ (i.e., no restrictions related to store sub-categories such as ‗health and wellness‘ were imposed). Results of the search were not

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limited by language and no date of app publication was used to restrict search results. Since the indexing of apps varied greatly across app stores, we conducted a calibration exercise prior to app selection in order to verify our ability to detect pain apps. Specifically, we tested our search criteria for the ability to find pain apps that were known to be currently available in the app stores. In all cases, our search criteria identified the apps we expected to find. Selection of apps Apps were included in the study if the goal of the app was the treatment or mitigation of pain and the primary intended user of the app was a person in pain. Apps were excluded if they focused only on the services offered by specific pain clinics because they were intended as advertisements for these clinics. These ‗clinic apps' typically included only lists of the pain management services and personnel available at the clinic and directions to the clinic rather than self-management programming. Apps were also excluded if they were classified as ―e-books‖ by the respective app store or were judged by the reviewers as such. Two authors performed app selection independently and all discrepancies regarding selection were resolved through discussion with a third party. There was greater than 75% agreement between authors across all app stores prior to third party resolution. Data abstraction Metadata from all included apps were abstracted into a standard Microsoft Excel spreadsheet. The source for all metadata was the respective app store where the app was identified. Abstracted metadata included: app name, developer (individual or organization), app description, customer rating on the day of store search (0 to 5 scale with no defined scale anchors provided by the store), number of customers, price, number of installations, and system requirements. A systematic approach to data abstraction was used. Specifically, two authors (JR,

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AA) abstracted all data and two others (CL and LJ) verified the data with reference to the app website. Functionality assessment As there are currently no established guidelines regarding the content of smartphonebased pain self-management programming, we used a researcher-developed list of important self-management functionalities for the purpose of this review. This list is based on the features of pain self-management programs that have been examined for effectiveness in scientific trials.6,8,26,27 To assess the comprehensiveness of app functionality related to self-management, the following criteria were used: (a) having a pain tracking function, (b) ability to set goals related to improving pain and functioning, (c) provision of pain-related education, (d) provision skills training related to specific pain self-care strategies, and (e) provision of social support. These components were identified based on their inclusion in face-to-face self-management programs for persons with pain, which have demonstrate effectiveness through randomized controlled trials.8,28 For each criterion, we assessed coverage as either ‗present‘ or ‗absent‘. We also assessed whether a regulated healthcare professional had provided clinical expertise related to development of the app content and function. An app was required to reference the involvement of a healthcare professional listed in the Ontario Regulated Health Professions Act29 to meet this criterion. This list contains 24 healthcare regulatory colleges to whom the Ontario government has endowed the capacity to regulate the practices of corresponding healthcare professionals to ensure safe and ethical patient care. The list includes healthcare professions such as physicians, nurses, physical therapists, etc. If an app claimed the

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input of a profession that was not listed in the Act (e.g., hypnotist) in its development, we did not assess the app as having healthcare professional involvement. Descriptions provided by the app store were also examined for any reference to the app being part of formal scientific research (e.g., used in a cohort study, evaluated for feasibility or effectiveness on patient, provider, or health system outcomes). The app description and corresponding developer website were reviewed to determine whether any specific theoretical framework had been used to guide the development of app program content (e.g., theory of health behavior change). Lastly, large publicly accessible scientific literature databases (i.e., NCBI PubMed and Google Scholar) were searched using the app name as a query for any published research related to the app. Descriptive statistics were used to summarize the results of the content assessment.

SECTION 3. RESULTS Our original search across all app stores identified a total of 901 apps. Of these apps, 622 (69%) were excluded from further review based on the a priori inclusion and exclusion criteria. Primary reasons for app exclusion were: lack of ability to provide any self-management support and the intended end-user of the app being a healthcare provider rather than a person living with pain. Of the 279 apps included in this review, the majority (n=179; 64.2%) were identified in the Android store, while remainder were identified in the Windows (n=62; 22.2%), iTunes (n=25; 9.0%), and BlackBerry (n=13; 4.6%) stores, respectively (Supplementary Table, http://links.lww.com/CJP/A144 ). A limited number of identified apps (n=9; 3.2%) were crossplatform in nature with 5 being available in both the Android and iTunes stores, 2 available for

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Android and Windows, 1 available for Windows and BlackBerry, and 1 available for Android and BlackBerry. Summary of general app characteristics The identified apps were categorized in different ways both within and across each store. Overall, identified apps were most often classified as ‗medical‘, ‗lifestyle‘, or ‗health and fitness‘. The cost of apps also varied, with approximately half (n=138; 49.5%) being free to download (Figure 1). The mean cost of the paid apps was CDN$3.44 +4.2, and the most expensive app was CDN$45.51. Several free apps were ‗limited versions‘ of apps with an associated cost for upgrade. In the case of these ‗freemium‘ apps, not all app features were available to users who chose not to pay for an upgrade. Consumers were provided the option of rating their user experience with each app on a 0 to 5 scale across all stores. However, a large number of apps were unrated (N=124; 44.4%). Within each store, the average rating was: 3.7±1.1 for Android, 3.8±1.6 for Windows, 3.8±0.75 for iTunes, and 3.1±1.3 for BlackBerry. The range in number of reviewers per app was 0 to 2205, with a mean of 25.5±146.9 reviewers. Self-management functionality of pain apps Apps claimed to be capable of providing consumers with several different means to aid in pain self-management. The most common pain self-management functionality claimed by apps was training for pain self-care skills (n=216; 77.4%). The self-care skills offered by each app varied both in terms of their subject matter and the evidence-base supporting their use. For instance, the self-care skills offered by identified apps included: muscle stretching, self-guided hypnosis, sound-assisted pain mitigation, and acupressure. Other common pain self-management functionalities of currently available apps included pain-specific education (n=128; 45.9%) and

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pain self-monitoring, providing users with the ability to track pain over time (n=53; 19%). Pain education apps generally focused on providing information about the pathophysiology and the etiology of painful conditions. Self-monitoring apps provided users with the ability to track their pain over time, with some providing the ability to enter reports daily or on an ad hoc basis when a person was in pain. A number of apps with self-monitoring functionality included audible reminders to improve adherence with tracking by prompting users to enter pain reports. A minority of these apps also provided users with the ability to track the multidimensional experience of pain by assessing not only pain as a sensory phenomenon, but also as an emotional and cognitive experience.30 There were a small number of apps with the ability to assist users in engaging in social support (n=10; 3.6%) and pain–related goal-setting (n=2; 0.72%). In the case of these apps, social support included the ability to engage with social media outlets (e.g., Facebook, Twitter) via the app or app-associated communities where users engage via dedicated message boards. The ability to assist users in goal-setting was the least frequent self-management functionality included in available apps. Goal-setting functionalities allowed users to select goals from lifestyle categories related to pain management, including exercise, treatments and rest, and track their progress with respect to that goal overtime. Comprehensiveness of pain apps As shown in Table 1, the relative representation of pain self-management functionality per app in each store varied. A majority of the apps (n=164; 58.5%) identified through this review included only 1 of the 5 functionalities that were used as criteria to characterize selfmanagement interventions. One hundred and six apps (38%) included two of these selfmanagement functionalities. The remainder of apps included 3 (n=3; 1.1%) or 4 (n=6; 2.2%) functionalities, and not a single app included all 5 of the self-management functionalities.

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App evaluation Almost none of the apps included in this review described the engagement of a regulated healthcare professional in the development of content or functionality. In particular, n=256 (91.8%) apps did not report any healthcare professional involvement. Among the 23 apps that did report healthcare professional involvement, 17 (73.9%) were from Android, (n=5; 21.7%) were from iTunes, and 1 (4.3%) was from Windows. The BlackBerry store did not contain any apps that reported healthcare professional involvement. None of the identified apps were referenced through PubMed or Google Scholar searches. Only a single app (0.4% of all pain self-management apps) described being involved in any scientific evaluation. This app (“CatchMyPain”) is part of a large-scale longitudinal descriptive study of the multidimensional experience of pain in people living with chronic pain. Finally, no identified apps reported the use of a theoretical model or established clinical rationale as being the basis for app design. SECTION 4. DISCUSSION This review has demonstrated that despite the availability of numerous pain apps across different platforms, few of these apps offer the theoretically- and empirically–supported strategies typically provided by face-to-face self-management programs.4,8,15 Additionally, almost none of the identified apps were developed or evaluated using scientific methods. The Android store contained the largest number of pain self-management apps. This finding is in contrast to a previous app store review, conducted between June and August 2010, which showed that the iTunes store was the most abundant for pain-related apps.24 This change in distribution is likely due to the more stringent app publication criteria imposed by the iTunes store and the increase in popularity of the Android platform over recent years.31 The majority of

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identified apps were free for download, potentially increasing their accessibility to people with pain. The user ratings of apps across all stores was moderate, with the mean rating of all reviewed pain apps never being less than 3.1 out of 5. Although this is heartening with respect to user acceptability, it is important to note that a large number of apps were unrated (44.4%) or rated only by a small number of users. Without a large sample of reviewers, estimates of true user perceptions regarding apps are imprecise. Our review demonstrates that there continues to be major limitations in the field of patient-focused pain self-management apps. Namely, current pain apps are characterized by a lack of: (a) integrated features allowing for personalization through goal-setting, self-monitoring, self-care skills development, education, and social support; (b) involvement of healthcare professionals in development and evaluation; (c) foundation in current research or behavioral theories; and (d) scientific evaluation either through feasibility or effectiveness testing. This last finding is in agreement with the results of three recent systematic reviews of ehealth and m-health interventions, which failed to identify any large-scale randomized controlled trials that evaluated the effectiveness of pain apps on health outcomes.32-34 Thus, while technology-based intervention (especially smartphone) is a burgeoning field, formal evaluations of impact, level of resource utilization, and user satisfaction have lagged far behind app development.24,35,36 Given the importance of developing the highest quality interventions in terms of evidence-based effectiveness, safety, and patient-centeredness, rigorous scientific testing of available pain self-management apps is much needed. Needed content elements for pain self-management apps

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At present, there is not a widely accepted framework or set of clinical recommendations detailing the key components needed in effective pain self-management programs. However, best clinical practices37 and qualitative interviewing18,38 of people living with pain endorse the inclusion of 5 theory-based functionalities for these programs: self-care skills instruction, painrelated education, self-monitoring, goal-setting, and social support. The personalized self-care instruction functionality should provide ‗in the moment‘ access to pain coping strategies to promote positive changes in mood, behavior, and ultimately pain. Content should be based upon the theoretical underpinnings of cognitive behavioral therapy39,40, and include self-care strategies such as muscle relaxation, guided imagery, mindfulness, and breathing, as well as problemsolving and communication skills training. Self-care skill assistance is the most common functionality offered by currently available pain apps, however, the quality of this skill assistance is questionable. App developers offer vague descriptions of skills and the evidence-base for many of the offered self-care skills is lacking. Without grounding in the best possible evidence, the effectiveness of these apps in assisting people with pain self-management is not known. In this study, pain-related education was the second most common self-management functionality incorporated into current pain apps. This finding could be related to the relatively low cost to developers to include text-based educational material compared to more complex multimedia content (e.g., video, audio). Although we did not download and review the educational content of each app, the quality of the material appeared to be generally poor based on the app description and screenshots. The overall lack of healthcare professional involvement in the development of educational material for apps is also worrisome. Our search identified apps capable of pain self-monitoring, but these apps were often simplistic and lacked the ability to track the important and complex multidimensional experience

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of pain.41,42 Instead, identified apps focused primarily on monitoring the intensity of pain and often did not collect detailed information about other important components such as pain quality and location. There was also a lack of audible and visual reminders to encourage routine pain data documentation.43 The goal-setting functionality of apps can enhance self-efficacy, defined as perception of one‘s ability to successfully produce a desired effect in a task or behavior affecting their life.44 Effective goal-setting should guide users in setting structured goals aimed at improving pain and functioning.45,46 It has been recommended that pain-related goals adhere to the SMART framework – specific, measurable, achievable, realistic, and timed.47 Only 2 identified apps were capable of assisting users in developing and meeting SMART goals, suggesting this is again an important area for future app development. Finally, the ability to interact and share coping strategies with others through social support has been suggested to result in improved pain self-management.48 A minority of available apps (n=10; 3.6%) provided users with the ability to engage and learn from others with pain. Additionally, despite the need for comprehensive functionality, 96.8% of identified pain apps included only 1 or 2 of these important features, suggesting an opportunity for improvement in the breadth of app function. Limitations We independently developed a search strategy to scan each app store. Search facilities are an important issue when conducting research in commercially available apps because these online stores do not provide consistent product indexing. We modeled the search after those previously conducted in this area.24,25 We also enhanced the search by contacting personnel at each app store for input on search strategies. Additionally, although we attempted to be

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comprehensive in our abstraction of data related to each app, we did not download apps for a thorough review. Instead, we relied on information available on the app store and associated websites. It is important to note, however, that most people with pain are likely to follow a similar strategy when choosing apps for their own pain management. Lastly, the online app stores currently allow customers to rate their experience using each app on a 0-5 point scale. However, none of these store-designed rating scales have defined anchors, which limits our ability to interpret the factors that are driving user ratings. There is clear scope for future research in the area of consumer-oriented pain management apps. First, research attention should focus on the development of a comprehensive pain self-management app that incorporates both healthcare professionals and patients in its design. Next, there is a need to rigorously refine and test these apps for effectiveness using highquality feasibility tests and multi-center randomized controlled trials. Required pain selfmanagement support for patients is also likely to differ based cultural values, age, gender, and developmental stage. Therefore, app design should be tailored to the needs of individual patient groups to improve impact on patient and system outcomes. Lastly, there is an important need to develop and utilize standard criteria for the evaluation of medically focused apps, including those for pain. Through the creation of such criteria, apps may be objectively compared, healthcare professionals may make informed recommendations regarding the prescription of apps, and patients may feel an enhanced sense of safety with app use. Conclusion Overall, this review has shown that although there are a large number of pain selfmanagement apps, the content of most apps is poor. Although there are no established requirements for the necessary elements of pain self-management programs, it is generally

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accepted that multi-modal programming focused on behavior change is needed. Still, the vast majority of available apps include only 1-2 self-management functionalities. Healthcare professional involvement in app development is also needed to improve the clinical effectiveness and relevance of app content. Interestingly, despite recommendations from Rosser and Eccleston, the percentage of apps without healthcare professional involvement (i.e. 91.8% versus 86.1%) has not improved since 2011.24 This finding, combined with the lack of both scientific evaluation and content grounding in theory and clinical rationale, means that it is not appropriate for the majority of currently available apps to be recommended to patients. Given a very real potential to improve health outcomes, future research is urgently needed to develop a comprehensive, evidence-based, and clinically informed smartphone self-management app for people living with pain.

Acknowledgements We would like to thank Dr. Benjamin Rosser and Dr. Christopher Eccleston for providing early guidance on our search strategy based on their previous review of smartphone apps for pain. We have no conflicts of interest to disclose.

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References

1. Blyth FM, March LM, Nicholas MK, Cousins MJ. Self-management of chronic pain: a population-based study. Pain 2005;113:285-292. 2. Foster G, Taylor SJ, Eldridge SE, Ramsay J, Griffiths CJ. Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database Syst Rev 2007;CD005108. 3. Eccleston C, Williams A, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2009;CD007407. 4. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns 2002;48:177-187. 5. Lawson EF, Hersh AO, Applebaum MA, Yelin EH, Okumura MJ, von Scheven E. Selfmanagement skills in adolescents with chronic rheumatic disease: A cross-sectional survey. Ped Rheum 2011;9:35. 6. Palermo TM, Eccleston C, Lewandowski AS, Williams AC, Morley S. Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: an updated meta-analytic review. Pain 2010;148:387-397. 7. Stinson JN, Wilson R, Gill N, Yamada J, Holt J. A systematic review of internet-based selfmanagement interventions for youth with health conditions. J Pediatr Psychol 2009;34:495-510. 8. McGillion MH, Watt-Watson J, Stevens B, Lefort SM, Coyte P, Graham A. Randomized controlled trial of a psychoeducation program for the self-management of chronic cardiac pain. J Pain Symptom Manage 2008;36:126-140. 9. Elgar FJ, McGrath PJ. Self-administered psychosocial treatments for children and families. J Clin Psychol 2003;59:321-339. 10. Barlow JH, Ellard DR. The psychosocial well-being of children with chronic disease, their parents and siblings: an overview of the research evidence base. Child Care Health Dev 2006;32:19-31. 11. Fisher E, Heathcote L, Palermo TM, de C Williams AC, Lau J, Eccleston C. Systematic Review and Meta-analysis: Psychological Therapies for Children with Chronic Pain. J Ped Psych 2014; 39:866-886. 12. Dennis CL. Peer support within a health care context: A concept analysis. Int J Nurs Stud 2003;40:321-332.

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13. Forgeron P, King S, Stinson JN, McGrath PJ, MacDonald AJ, Chambers CT. Social functioning and peer relationships in children and adolescents with chronic pain: A systematic review. Pain Res Manag 2010;15:27-41. 14. Dale J, Caramlau IO, Lindenmeyer A, Williams SM. Peer support telephone calls for improving health. Cochrane Database of Systematic Reviews 2008;4: CD006903. DOI: 10.1002/14651858.CD006903.pub2. 15. Ory MG, Ahn S, Jiang L, Lorig K, Ritter P, Laurent DD, Whitelaw N, Smith ML. National Study of Chronic Disease Self-Management: Six-Month Outcome Findings. J Aging Health 2013;25:1258-1274. 16. Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2012;11:CD007407. 17. Eccleston C, Palermo TM, de C Williams A, Lewandowski A, Morley S, Fisher E, Law E. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2012;12:CD003968. 18. Stinson JN, Isaac L, Campbell F, Brown S, Ruskin D, Gordon A, Galonski M, Pink L, Buckley N, Henry JL, White ME, Lalloo C, Karim A. Understanding the information and service needs of young adults with chronic pain: Perspectives of young adults and their providers. Clin J Pain 2013;29:600-612. 19. Huguet A, Miró J. The severity of chronic pediatric pain: an epidemiological study. J Pain 2008;9:226-236. 20. Lynch ME, Campbell F, Clark AJ, Dunbar MJ, Goldstein D, Peng P, Stinson JN, Tupper H. A systematic review of the effect of waiting for treatment for chronic pain. Pain 2008;136:97116. 21. Peng P, Choinière M, Dion D, Intrater H, Lefort S, Lynch M, Ong M, Rashiq S, Tkachuk G, Veillette Y, Group STOPPAINI. Challenges in accessing multidisciplinary pain treatment facilities in Canada. Can J Anaesth 2007;54:977-984. 22. Peng P, Stinson JN, Choinière M, Dion D, Intrater H, Lefort S, Lynch M, Ong M, Rashiq S, Tkachuk G, Veillette Y, Group STOPPAINI. Dedicated multidisciplinary pain management centres for children in Canada: the current status. Can J Anaesth 2007;54:985-991. 23. Demiris G, Afrin LB, Speedie S, Courtney KL, Sondhi M, Vimarlund V, Lovis C, Goossen W, Lynch C. Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group. J Am Med Informatics Assoc: JAMIA 2008;15:8-13.

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24. Rosser BA, Eccleston C. Smartphone applications for pain management. J Telemed Telecare 2011;17:308-312. 25. Reynoldson C, Stones C, Allsop M, Gardner P, Bennett MI, Closs SJ, Jones R, Knapp P. Assessing the Quality and Usability of Smartphone Apps for Pain Self-Management. Pain Med 2014 26. Stinson JN, McGrath PJ, Hodnett ED, Feldman BM, Duffy CM, Huber AM, Tucker LB, Hetherington CR, Tse S, Spiegel LR, Campillo S, Gill NK, White ME. An internet-based selfmanagement program with telephone support for adolescents with arthritis: a pilot randomized controlled trial. J Rheum 2010;37:1944-1952. 27. Lorig K, Holman H. Arthritis self-management studies: a twelve-year review. Health Educ Q 1993;20:17-28. 28. Kravitz RL, Tancredi DJ, Grennan T, Kalauokalani D, Street RL, Slee CK, Wun T, Oliver JW, Lorig K, Franks P. Cancer Health Empowerment for Living without Pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment. Pain 2011;152:1572-1582. 29. Ontario Ministry of Health. Regulated Health Professions Act, 1991. 2013;S.O. 1991, CHAPTER 18 30. Melzack R, Casey KL. Sensory, Motivational, and Central Control Determinants of Pain: A New Conceptual Model. The Skin Senses. Springfield: Thomas., 1968:423–443. 31. Pew Research Center. Smartphone Ownership — 2013 Update. 2013;1-12. Available at: http://www.pewinternet.org/files/oldmedia//Files/Reports/2013/PIP_Smartphone_adoption_2013_PDF.pdf. Accessed 14 July 2014 32. Krishna S, Boren SA, Balas AE. Healthcare via cell phones: a systematic review. Telemed J E Health 2009;15:231-240. 33. Rosser BA, Vowles KE, Keogh E, Eccleston C, Mountain GA. Technologically-assisted behaviour change: a systematic review of studies of novel technologies for the management of chronic illness. J Telemed Telecare 2009;15:327-338. 34. Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform 2010;79:736-771. 35. King D, Greaves F, Exeter C, Darzi A. 'Gamification': Influencing health behaviours with games. JRSM 2013;106:76-78.

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36. Griffiths F, Lindenmeyer A, Powell J, Lowe P, Thorogood M. Why are health care interventions delivered over the internet? A systematic review of the published literature. J Med Internet Res 2006;8:e10. 37. McGillion MH, LeFort S, Webber K, Stinson JN. Pain self-management: theory and process for clinicians. Clinical Pain Management: A Practical Guide, 1st edition. Blackwell Publishing Ltd., 2011:193-199. 38. Stinson JN, Lalloo C, Harris L, Isaac L, Campbell F, Brown S, Ruskin D, Gordon A, Galonski M, Pink L, Buckley N, Henry JL, White M, Karim A. iCanCope with Pain: Usercentred design of a web and mobile based self-management program for youth with chronic pain based on identified healthcare needs. Pain Res Manag 2014 39. Kazantzis N, Freeman MA. Cognitive and Behavioural Theories in Clinical Practice. New York: The Guilford Press., 2010. 40. Sharp TJ. Chronic pain: a reformulation of the cognitive-behavioural model. Behav Res Ther 2001;39:787-800. 41. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975;1:277-299. 42. Schiavenato M, Craig KD. Pain assessment as a social transaction: beyond the "gold standard". Clin J Pain 2010;26:667-676. 43. Stinson JN, Jibb LA, Nguyen C, Nathan PC, Maloney AM, Dupuis LL, Gerstle JT, Alman B, Hopyan S, Strahlendorf C, Portwine C, Johnston DL, Orr M. Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer. J Med Int Res 2013;15:e51. 44. Bandura A. Self-efficacy: the exercise of control. New York: WH Freeman, 1997. 45. Jensen MP, Turner JA, Romano JM. Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment. Pain 1991;44:263-269. 46. Schunk DH. Enhancing self-efficacy and achievement through rewards and goals: Motivational and informational effects. J Educ Res 1984;78:29-34. 47. Bovend'Eerdt TJ, Botell RE, Wade DT. Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clin Rehabil 2009;23:352-361. 48. Bandura A. Social learning theory. Englewood Cliffs: Prentice Hall, 1971.

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FIGURE CAPTION: Figure 1. Download cost for pain-related apps across different stores

Table 1. Presence of self-management functionalities across pain-related apps Pain selfmanagement component Self-care skills training

Education

Self-monitoring

Social support

Goal-setting

Application content functionality Training on pain self-care techniques

Content details

Provision of written, graphical or audiovideo instruction on pain management skill (e.g., relaxation, distraction) Pain-specific Provision of written, education graphical or audiovideo education related to pain and its treatment Pain tracking Capacity to log pain reports longitudinally and/or review previous logged reports Access to a Provision of access to community of other persons in pain persons living through the app for the with pain purpose of providing emotional, informational, and appraisal support Pain and function Capacity to set goals goal-setting and regarding pain tracking management, as well as physical and mental function, and track goal progress over-time

Applications N (%) 216 (77.4%)

128 (45.9%)

53 (19%)

10 (3.6%)

2 (0.72%)

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Figure 1 - Cost of Pain Apps Click here to download high resolution image

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"There's a Pain App for That": Review of Patient-targeted Smartphone Applications for Pain Management.

There are a growing number of pain self-management applications (apps) available for users to download on personal smartphones. The purpose of this st...
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