According to the CDC’s National Health Interview Survey, the number of Americans suffering from chronic pain is on the rise. In 2019, 20.4% of adults experienced chronic pain with 7.4% afflicted by high-impact chronic pain – limiting their life or work activities. In 2023, the overall figure rose to 24.3%, with 8.5% suffering from high-impact pain.
The emotional trials and tribulations of dealing with chronic pain have also gained renewed public attention following Luigi Mangione’s recent revelation about his chronic pain struggles, sparking widespread discussions on social media surrounding how pervasive yet often invisible and isolating chronic pain can be.
For clinicians, treating this persistent condition is no less frustrating. Despite a widely held understanding within the provider community that chronic pain is often biopsychosocial in nature, the standard of care for addressing the mental health impacts are often limited to a hospital-distributed pamphlet, or a referral to the single hospital therapist on staff, who may only be available out-of-pocket.
As a result, patients frequently end up in an endless cycle of visits with a care plan that’s centered on pharmacological treatment alone and which fails to address the emotional and lifestyle factors which impact pain.
The Promise of Chatbot Care
The desire to be able to provide chronic pain patients with a wider set of resources is so pronounced in fact, that some clinicians are proactively pursuing and investigating new treatment modalities themselves.
Wysa’s own work in chronic care began this way, as we partnered with leading orthopedist Dr. Abby Cheng, at Washington University in St. Louis, to further research the efficacy and opportunities for mental health chatbots in chronic pain applications.
Through multiple peer-reviewed studies, we observed clinically significant reductions across PROMIS Depression, Anxiety, Pain Interference and Physical Function scales with the utilization of Wysa for an 8-week period.
While digital therapeutics are rapidly expanding in use across healthcare applications, chronic pain presented a unique challenge in that the majority of patients are older. Through our studies, we were interested to investigate whether older patients felt comfortable using an app and what specific accessibility challenges may need to be addressed.
In fact, in looking at a cohort with the average patient aged 55 and having suffered from chronic pain for 8.4 years, we saw average retention of the tool topping 51 days, or four times the industry standard. It turned out that apart from forgetting their Apple password (and who among us has not been guilty of that), patient age did not represent a significant barrier to engagement for app-based therapy in this case.
The Next Horizon: Just-in-Time Adaptive Interventions
The more prevalent barriers we did note were specific to the individual and their lifestyle or pain itself. For example, for patients suffering from arthritis in their fingers, typing into the chat could at times become uncomfortable and the ability to speak to the chatbot verbally would offer relief. For others, their pain may present itself more readily during certain times of day or during specific activities, meaning if we could proactively offer care at that time or when their geolocation showed they were in a certain place, we could be even more targeted.
Recognizing this opportunity has led to the current research we’re doing into Just-in-Time Adaptive Interventions (JITAIs). Funded by a grant from the National Institute of Mental Health (NIMH), this four-year project led by Washington University in St. Louis will fuel the development of even more tailored intervention mechanisms within Wysa for Chronic Pain to provide more targeted care.
Getting New Therapeutics into Patients’ Hands
It’s clear that research and development efforts are showing promise for digital inventions to finally provide chronic pain patients with more psychosocial support but obstacles still remain to ensuring these new therapeutics can make it to patients.
Most critically, new treatments with demonstrated efficacy need acknowledgement and support from payers to see the widest adoption. Covered care codes for chronic pain must be re-evaluated to ensure the most modern, effective treatments available today are being offered to patients in need. This is payers’ opportunity to remedy the gap between the known holistic, biopsychosocial factors that impact chronic pain, and the extremely limited and arguably outdated list of covered treatments.
With payers onboard, and providers and patients ready to embrace new treatment modalities, chronic pain care may finally have a brighter future ahead.
