Digital Interventions for Pain and Addiction

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Rebecca G. Baker, Ph.D.

Rebecca G. Baker, Ph.D., is the director of the NIH HEAL Initiative®Read more about Dr. Baker.

Now a commonplace term, the word “digital” originates from computer-based processes that operate according to the language of the digits 0 and 1. Digital tools are thus electronic versions of communication, measurement – and increasingly, tools for improving health. Digital tools offer both convenience (they go where we go) and precision (they can measure real-time output). Of interest to HEAL, according to a recent market analysis, the vast majority of digital therapeutics target disorders affecting the brain, such as substance use, pain, and mental health conditions.

Although digital interventions have been around for some time, they gained traction during the pandemic. As a result, interest and use in digital health tools has expanded. Ongoing HEAL research is thus important for providing evidence to guide use of effective technologies and to inform policies and insurance coverage. This month, I’ll talk about what we hope to learn from research testing digital interventions and why it’s an important focus for HEAL.

Digital Health Promotes a Whole Person Focus

For many people, mobile devices and apps let us access the internet anywhere, anytime (given good connectivity, which is still a significant problem across the country). HEAL researchers are developing and testing biological sensors, health coaches, and connections to peer support. Selected examples include:

Digital Interventions Help People See or Feel Things in a Different Way

Beyond convenience and flexibility, digital tools allow people to experience a range of outcomes safely, by providing a virtual platform. HEAL researchers are developing and testing educational video games, virtual reality, opportunity-based messaging, and others. Selected examples include:

  • PlaySmart is a serious, yet highly engaging video game that uses simulated experiences to help teens and young adults consider outcomes of risky behavior in advance.
  • Virtual reality devices are being tested for their ability to reduce the sensation of chronic back pain (which may lead to lower opioid use), reduce pain by immersing patients in three-dimensional immersive environments like walking up waterfalls, or to envision a personalized future with or without drug use.
  • An “artificial muscle” for people with back pain is a robotic device with built-in feedback that monitors how a person is moving and adjusts tension to encourage and allow safe movement.
  • A wearable device collects and analyzes information using machine learning and artificial intelligence to predict when a patient is at risk for leaving treatment early or returning to drug use.
  • A mobile tablet given to teens and young adults during an emergency department visit offers routine HIV testing and counseling privately and discretely.

Digital Tools Help Researchers and Providers Be Accurate

Another important use of digital tools is to advance research and improve clinical care with precise, unbiased collection of information. Selected examples include:

  • A wearable monitor measures and compares back and/or neck movement in people with low back pain disorders as well as in people with healthy spines, to identify predictive factors for low back pain.
  • A wrist-worn sensor detects motion, heart rate, skin surface temperature, and skin conductivity to help rate functional impairment from chronic pain.
  • An in-depth digital training program teaches addiction treatment counselors how to encourage friends and family members to help individuals seek treatment.
  • A smartphone-based wireless device monitors leg-abdominal muscle interactions in real-time in women with chronic pelvic pain to guide home-based physical therapy.
  • Decision-making tools embedded into electronic health records offer patients complementary and integrative pain treatment options after surgery or advisories for providers to identify people at high risk for developing opioid use disorder and offer treatment. 

For people with physical and emotional pain, digital interventions may appear to be a lifeline. Yet even for seemingly safe apps and devices, people (and providers) may not know about them or if they really work. Healthcare systems aren’t sure how to fit them into clinical workflows. Many people are concerned about privacy. For these and other reasons, the marketplace can be unpredictable, given unclear demand.

The digital world is here to stay, and healthcare is adapting rapidly – some say too fast. As more and more products are developed for science and health applications – in particular for complex conditions like pain and addiction – there is a vital role for research to make sure these products are safe, and that they help people get better.

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