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摘要: 慢性疼痛具有发病率高、迁延难愈的特点，不仅严重困扰着患者，其临床治疗亦面临巨大挑战。数字疗法(digital therapeutics, DTx)是一种由软件程序驱动，以循证医学证据为基础的新兴治疗方法，可基于数字化网络为患者提供个体化疾病管理策略，在提高治疗依从性的同时，为临床收集相关数据提供了诸多便利，为慢性疼痛的治疗提供了新思路和发展方向。本文围绕DTx在慢性疼痛诊疗中的应用进展作一综述，以期为临床进行慢性疼痛管理提供借鉴。Abstract: Chronic pain is characterized by a high incidence and persistent, challenging recovery. It not only significantly troubles patients but also poses substantial challenges for clinical treatment. Digital therapeutics (DTx), an emerging evidence-based therapeutic approach by software programs, provides individualized disease management strategies for patients through digital networks. DTx enhances treatment adherence and facilitates data collection, which can be used as a monotherapy or in combination with other therapies. This review aims to summarize the progress of DTx application in the diagnosis and treatment of chronic pain, with the goal of providing valuable insights for the clinical management of chronic pain.
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Key words:
- digital therapeutics /
- chronic pain /
- virtual reality /
- web-based platform
作者贡献：季和宇负责查阅文献，撰写论文；崔旭蕾、黄宇光负责指导、修订论文。利益冲突：所有作者均声明不存在利益冲突 -
表 1 用于慢性疼痛诊疗的APP软件
APP软件 干预方式 干预效果 疼痛类型 Kaia Health 人工智能算法指导物理治疗和康复，建立物理疗法 减轻疼痛和压力、提高舒适度 慢性背痛、骨关节痛 Habit Changer 关注疼痛管理认知行为的改变 提供与疼痛、心理、社会体验的任务和日常信息，通过自我监管程序指导个人进行疼痛管理 - Pocket Therapy 提供疼痛相关原因、部位与症状等信息、改善运动范围和肌肉力量练习；减轻疼痛的其他技术(温度控制、服用非甾体抗炎药和按摩) - - Chronic Pain Tracker 重新定义疼痛，包括强度、位置、类型、服用药物和自由注释；疼痛强度分级(0~10分)；提供人体图像可直观绘制疼痛位置 - - My Pain Diary 可输入多个变量：疼痛强度、部位、类型、触发因素、采取的补救措施和注释；疼痛强度为0~10分 - - Iposture 利用智能手机内置传感器从直立位置测量手机的角度，通过姿势改变提醒用户调整生活方式 - - Pain Guard 提供患者管理模块，患者可进行疼痛自测、记录和设置提醒通知；对疼痛进行评分，有专业的疼痛管理团队服务解答患者的疑问 - - -：表示暂无明确的临床研究及效果验证 
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表 2 VR在慢性疼痛治疗中的应用
VR 干预方式 干预效果 疼痛类型 SpiderWorld 沉浸式VR，分散注意力(如视频游戏) 疼痛得到缓解 烧伤痛 RelieVRx 基于身临其境的体验管理疼痛，正向引导患者获得理想的临床效果 疼痛评分降低，整体疼痛感减轻 中重度腰痛 BreatheVR 深呼吸技术与专门设计的虚拟场景相结合 4/5受试者表示短期内即可获得明显的疼痛缓解，余受试者表示疼痛缓解不佳 - Flowly 将VR与应用程序相结合，通过生物反馈技术管理疼痛 疼痛评分及剧烈疼痛发生率均降低，阿片类药物用量减少 - Exergame+HoloTour 根据患者需求创建个体化VR锻炼游戏，激励患者定期进行锻炼 - 慢性腰背痛 VR: 同图 1；-: 表示暂无明确的临床研究及效果验证
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