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Revolutionising patient pain

A row of coloured balloons with faces drawn on them

Sometimes called the fifth vital sign, pain level is universal data for medical treatment. It acts as an indicator of concern, a factor towards Quality of Life, and as a means for optimising patient care. But getting regular pain data into medical records is difficult.

The current mainstream approach is labour intensive, requiring nursing staff to regularly query patients and manually enter the data. This can lead to low compliance and frequency as overloaded staff are forced prioritise other aspects of facilitating care. Furthermore, patients can sometimes feel inhibited about expressing their pain to another person. The knock-on effect of this is poor reporting of pain is ineffective diagnosis and treatment, with patients suffering unnecessarily.

Having patients self-log their pain is an obvious solution to this problem and paper and pen pain diaries have been in use for many decades. However, they too suffer from very low compliance and low quality with patients trying to backfill from memory.

Transforming Pain Management

‘Transforming Pain Management’ is an Open Societal Challenge project with a vision to revolutionise how patient pain is recorded and treated. In 2018 The Open University (OU) began piloting a tangible digital device for older (45-85) orthopaedic in-patients to self-log pain after surgery – the Painpad (patent pending). The system has demonstrated modest success in both improving data quality and saving nursing staff time. The project’s long-term vision is to create a self-logging suite of tools (including for other patient reported data) for all types of in-patients and out-patients, across a range of ages and treatment conditions, that can send data live into medical records resulting not only improved patient care but also providing valuable data for medical research.

Following the pilot, the tool will be rolled out to enable large scale use across Milton Keynes University Hospital and integrate directly with Milton Keynes University Hospital’s E-Care. This is done by creating an Android and iOS app and a backend server to send data to the hospital. Design work has already begun for the Paediatric Painpad with the research team co-designing early prototypes with paediatric patients. Milton Keynes University Hospital will be a large-scale demonstrator and the project team will seek to begin trials in two more NHS hospitals as well as a private hospital.

Professor Blaine Price, who is leading the project said, “Initial published trials have demonstrated that the Painpad improves patient compliance compared to equivalent nurse scoring. As a physical device, the Painpad has advantages over a mobile app including being easily sterilised, available to all patients, and not needing any technology skills or high dexterity. The current design is based around older adults with varying digital technology skill levels making it highly user friendly. The app versions, however, will enable every patient to use it."

Dr Daniel Gooch, co-Director of the OU’s Digital Health Lab said, “While the Painpad data has not yet been used to support real-time clinical decision making, we are working with the orthopaedic team to analyse the collected data retrospectively. Our pathway to impact is based on building on this work to deepen its significance and increase the scale of deployment across Milton Keynes University Hospital followed by other NHS and private hospitals. Our ambition goes beyond Milton Keynes University Hospital, however, we are starting with a single site to showcase the significance of the technology before using the professional networks and organisation roles of our clinical collaborators to identify additional sites.”

Professor Oliver Pearce has been utilising the PainPad in practice and has found that it has not only saved nurses' time but also has led to collection of more accurate data. This is due to the PainPad prompting patients to upload their pain scores in real time, rather than trying to retrospectively remember them in a paper diary.

Professor Pearce discusses his experience of the PainPad and its advantages over other methods

What is the PainPad and what does it do for patients?

The PainPad came out of a conversation with a colleague, Professor Blaine Price. We were sat at a table, and he asked what was I missing that digital could help me solve and I said I was missing pain data after surgery for my patients that just automatically got uploaded to a spreadsheet where I could use it. I wanted a box with 10 numbers, 0 – 10, that would measure on a 0 – 10 scale, how much pain patients were in – 0 no pain, 10 horrendous pain. The first thing Professor Price said was “well that’s an app” and I said no, I want a box. I want a box that’s cheap, won’t be stolen, that has no intrinsic value and if it’s dropped in the soup, it really doesn’t matter. So, that we can hand them out to patients, they can put their pain scores in whilst they’re in hospital and then when they go home, we give them a wipe down with a sterile cloth and they can be logged to the next patient by their identifier number. So, I just get graphs of pain for all of my patients that I can then change things I do surgically to see if the before data is changed to the after data after I’ve made a change.

How is this different from what was being done before?

Well what was being done before was paper diaries. So you hand a paper diary to a patient and say please can you fill this in every couple of hours for the next six weeks, and the truth is you get about 30% of them bring them back, you lose 70% of the data. And those that do bring them back, you notice quite a similarity – it’s the same pen, everything perhaps has just been filled in minutes before the appointment when they hand it back to you and you wonder about the accuracy of the data. Whereas something that beeps you every couple of hours and something that automatically collates what you’ve got and there’s no source of error or human factors in it, is going to give me more accurate data – and more data – and that seems to have been actually what we’ve found.

What about inpatients, how were you recording pain for them?

So, inpatients are asked their pain by the nurse, the nurse then has to go away to the computer and register that pain score on the computer which doesn’t sound like it takes time, but if you’ve got 40 patients on the ward, it’s 40 times that period of time that they are doing something that could be easily done automatically by a little digital device such as the PainPad. So it’s a timesaver and it’s more accurate.

How do you know PainPad is more accurate?

Accurate is an interesting word here, we’re interested…it always showed a higher pain score than the one that the patients admitted to the nurse, usually by about 1 out of that 1 -10 scale. So - there you go, it’s beeping me to remind me – it would appear, this was just our conclusion, that patients don’t want to create work and they don’t want seem to be complaining when there’s a nice friendly nurse who’s been helping them for days, asking them their pain score, they will give one value. Whereas just minutes later, if the digital device to which they don’t have an emotional bond, asks the same thing, tends to be one pain score higher.

How is this an advantage over what nurses would normally do?

It’s an advantage in that the nurse doesn’t have to do work and nurses, Lord knows are busy enough and anything that takes some highly repetitious task out of their hands and frees them up for more proper nursing as they would call it, is going to be an advantage. It’s also easier if you like because the patient can do it in his or her own spare time without having to have a nurse coming and doing rounds to just collect pain scores from them.

What’s the next development for PainPad?

Well the next development is actually to have exactly the same 0 – 10 scale but on an app and it would then be on both typical platforms, the Android platform and the Apple platform, the IOS, so that you could have these same 0 – 10 scores but actually quite easily, when the patient goers home as well. I often call it the big black hole - when patients go home, I don’t know how they are. I see them six weeks later in the clinic when I’ve not known how they were in the previous six weeks. This would enable in a very simple way now that the majority of people have got a smart device, for them to be prompted with a beep, to upload their pain scores onto the device that then goes to this secure database where I can see their pain scores not just while they were in hospital but after they went home as well.