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App ‘helps’ improve pain control and reduces need for opiate use post surgery

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Knee replacement patients can reduce opiate painkiller use and improve pain control by using a smartphone app at home after surgery, according to researchers.

They found patients who underwent total knee replacement and used the PainCoach app at home after surgery consistently reduced opiate painkiller use and improved pain control.

“These are important findings given the current demands on the healthcare system”

Amar Sheombar

The more the study participants used the app, the more likely they were to lower pain scores and decrease their use of opioids, found the researchers.

For the study, the Dutch team randomly assigned 71 patients (aged 56-70 years) undergoing knee replacement to the app and usual care or usual care alone in the first 2 weeks at home after surgery.

The mobile app allows patients to input their pain level – no pain, bearable pain, unbearable pain, or untenable pain. Based on this and the amount of days after surgery, the app offers advice on drug pain relief use and exercises or rest.

Questionnaires were used to establish opiate use and pain levels at rest, during activity, and at night, as well as other pain drug use, experiences with exercises, pain acceptance, function, and quality of life.

Participants completed questionnaires preoperatively, daily during the first two weeks, and after one month. Amount of app use was also recorded, with “active use” defined as at least 12 uses of the app over two weeks.

During the study, average Visual Analogue Scale pain score was 23 – the scale is 0 to 100 where 100 represents the highest pain – and average opiate use across the group was less than half (0.4) of one 5mg oxycodone tablet per day.

Compared to the control group, users of the PainCoach app used 23% less opiates and 15% more paracetamol in the first 2 weeks following surgery.

Regular use of the app led to further reduction in opiate use and improved pain control during activity and at night, said the study authors.

Regular app users reported four times faster reduction in pain during activity, six times faster reduction in pain at night, and 44% less opiate and 76% less gabapentin use – taken to relieve nerve pain – compared to controls.

Opiate use was substituted by 21% more paracetamol use in regular app users.

Study author Dr Amar Sheombar, from Kliniek ViaSana, said: “These are important findings given the current demands on the healthcare system and the growing misuse of prescription painkillers worldwide.

“Few clinically-tested mobile apps exist with clear measurable goals to guide patients in pain control and opiate use at home after surgery,” he noted.

Dr Sheomber also highlighted that three-quarters of the study patients found the app valuable and wanted to use it for real-time feedback and support.

He added: “In the current study population opiate use was already low. The app might have a much stronger effect in patient populations where pre-operative opiate use is much higher.”

The research was presented earlier this month in Vienna at this year’s Euroanaesthesia Congress – the annual meeting of the European Society of Anaesthesiology.

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