Initial Testing of a Mobile App Pain Coping Intervention for Outpatient Oncology Settings

Pain is a common and distressing symptom for cancer patients. There is strong evidence that behavioral pain interventions – a non-pharmacological approach to pain management – are efficacious for decreasing pain. Yet, these interventions are not currently widely available to cancer patients due to a number of system, provider, and patient access barriers. Efficacious behavioral pain interventions that are technology-based (vs. face to face) have the potential to decrease access barriers and dramatically improve reach. A standalone mobile app would eliminate the need for a therapist, be available to the patient at all times, and be easily accessible on a personal smartphone or tablet. Mobile apps also offer increased options for real-time personalization (e.g., messaging based on daily pain assessment), which can increase engagement and improve overall outcomes. We have developed a mobile application – PainPac – that has been used as an adjunct to in person and videoconferencing interventions. We have not yet examined PainPac as a standalone intervention. PainPac is an innovative mobile app program that provides patients with coping skills modules of efficacious cognitive-behavioral theory-based pain management strategies. PainPac can be implemented through automated, electronic submission to patients via text, email, and/or MyChart (patient facing medical record) based on a clinical pain report (> 4/10) at a clinical oncology appointment. Our long-term goal is to use mobile app technologies to facilitate widespread implementation of efficacious behavioral cancer pain interventions. The overall objective of this application, which is the next step toward attainment of our long-term goal, is to demonstrate that a mobile app intervention, compared to standard videoconferencing sessions, is feasible (primary aim) and a promising strategy to decrease pain in patients with cancer. Our central hypothesis is our standalone mobile app behavioral cancer pain intervention (PainPac) will demonstrate high feasibility, as well as low patient burden, high engagement, and high acceptability that is at least comparable to a videoconferencing protocol (PCST-Video). We will use a randomized controlled trial to test three aims. The first aim is to test whether PainPac is feasible (primary aim), as well as low burden, engaging, and acceptable to cancer patients. The second aim is to examine the impact of PainPac on pain severity and interference, pain disability, pain self-efficacy, and quality of life. The third aim is to gather qualitative post-treatment data on cancer patients’ preferences, barriers, and facilitators regarding PainPac to optimize PainPac for a future large randomized clinical effectiveness trial. This work has the potential to create a paradigm shift for behavioral pain intervention practice. If PainPac is feasible and beneficial for helping cancer patients learn to manage their pain, the mobile app is poised to be widely disseminated ultimately decreasing pain and suffering for patients with cancer.