A Mobile Phone Application for Assessing Daily Variation in Pain Location and Pain Intensity in Patients with Urologic Chronic Pelvic Pain Syndrome: A MAPP Network Study

Abstract

Introduction: We created and tested a mobile app that facilitates the ecological momentary assessment of pain intensity and pain location and identifies heterogeneous patient pain phenotypes.

Methods: A mobile app was created with patient, clinician and researcher input. A sample of 20 participants with urologic chronic pelvic pain syndrome were then asked to complete a 14-day pain assessment using the app. Data were analyzed to assess compliance, usability and the ability for the app to capture variation in pain intensity and pain location. Ecological momentary assessment pain data were then compared to end-of-week pain summary questions to determine construct validity.

Results: Mean compliance was 70±8%, higher earlier in the study period (p <0.0005) and better in older individuals (p <0.0001). During the 14-day assessment, 90% of participants reported daily variation in pelvic pain intensity (SD 0.64-3.02; out of 10), 95% reported variation in their nonpelvic pain (SD 0.17-3.63; out of 10) and 100% reported variations in number of sites with pain (SD 0.22-1.44; out of 7). Pelvic pain and nonpelvic pain intensity, as determined by cumulative app scores, were associated with patient reported end-of-week scores; worst pain (r _pelvic =0.67; r _nonpelvic =0.53) and average pain (r _pelvic =0.78; r _nonpelvic =0.73).

Conclusions: The easy-to-use app captured unique patterns of pain not fully captured by traditional end-of-day/week summary questions or by traditional in-office assessments. Mobile apps for assessing chronic conditions will become increasingly important as telehealth becomes more commonplace.

Keywords: data collection; ecological momentary assessment; mobile applications; prostatitis.

Figure 1.

A, coordination site identifies participant. B, research coordinator loads (M)APP onto participant phone and instructions are provided on usability functions. C, once installed onto phone, app will communicate with server providing only phone ID. D, server communicates with coordination site, informing site that participant has enrolled. E, server communicates with Amazon Simple Notification Service (SNS). F, Amazon SNS communicates with participant phone via notification system. G, questionnaire information is relayed back to server. H, daily data relays send data from server to coordination site (where deidentified data then becomes identifiable and usable for study purposes).

Figure 2.

Screenshot of phone-based body maps and visual analog pain scale

Figure 3.

A, overall compliance by study day (black) and with daily variation by time of day. B, app usability as measured by NASA Task Load Index (20). Error bars represent 95% CIs using bootstrapping. All ratings are on a 1 to 10 scale. Higher scores in performance and compliance categories indicate better patient reported performance and compliance (p value represents significant change in overall compliance by day of study).

Figure 4.

a, heat map depicting max—min number of sites with pain by participant by day with average±SD of daily pain sites (left) and compliance (% of pain assessments completed out of 56 total; right; Examples: Participant #16: Pain in 6 sites on Day 1; pain in 2 sites on day 9; did not respond to pain questions on day 20 [grey]—average number of sites per day was 3.26 with significant individual variability [SD] of 1.44 sites. Participant completed approximately 60% of pain assessments over the 14-day study period.) b, heat map depicting max–min of pelvic pain by participant by day with average±SD of daily pain (left) and compliance (% of pain assessments completed out of 56 total; right). c, heat map depicting max—min of nonpelvic pain by participant by day with average±SD of daily pain sites (left) and compliance (% of pain assessments completed out of 56 total; right). Squares with any color other than light yellow depict a change in pain location throughout study day.