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数字疗法在慢性疼痛诊疗中的应用进展

季和宇 崔旭蕾 黄宇光

季和宇, 崔旭蕾, 黄宇光. 数字疗法在慢性疼痛诊疗中的应用进展[J]. 协和医学杂志, 2023, 14(5): 1046-1052. doi: 10.12290/xhyxzz.2023-0086
引用本文: 季和宇, 崔旭蕾, 黄宇光. 数字疗法在慢性疼痛诊疗中的应用进展[J]. 协和医学杂志, 2023, 14(5): 1046-1052. doi: 10.12290/xhyxzz.2023-0086
JI Heyu, CUI Xulei, HUANG Yuguang. Recent Advances of Digital Therapeutics in Treatment of Chronic Pain[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(5): 1046-1052. doi: 10.12290/xhyxzz.2023-0086
Citation: JI Heyu, CUI Xulei, HUANG Yuguang. Recent Advances of Digital Therapeutics in Treatment of Chronic Pain[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(5): 1046-1052. doi: 10.12290/xhyxzz.2023-0086

数字疗法在慢性疼痛诊疗中的应用进展

doi: 10.12290/xhyxzz.2023-0086
基金项目: 

中央高水平医院临床科研专项 2022-PUMCH-B-007

详细信息
    通讯作者:

    崔旭蕾, E-mail: cuixulei10685@pumch.cn

  • 中图分类号: R441.1

Recent Advances of Digital Therapeutics in Treatment of Chronic Pain

Funds: 

National High Level Hospital Clinical Research Funding 2022-PUMCH-B-007

More Information
  • 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。
    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
  • 图  1  数字疗法干预手段

    VR: 虚拟现实技术; APP: 移动医疗应用程序

    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
    下载: 导出CSV

    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
    下载: 导出CSV
  • [1] 宋学军, 樊碧发, 万有, 等. 国际疼痛学会新版疼痛定义修订简析[J]. 中国疼痛医学杂志, 2020, 26: 641-644. https://www.cnki.com.cn/Article/CJFDTOTAL-ZTYZ202009003.htm
    [2] Davis KD, Moayedi M. Central mechanisms of pain revealed through functional and structural MRI[J]. J Neuroimmune Pharmacol, 2013, 8: 518-534. doi:  10.1007/s11481-012-9386-8
    [3] Descalzi G, Ikegami D, Ushijima T, et al., Epigenetic mechanisms of chronic pain[J]. Trends Neurosci, 2015, 38: 237-246. doi:  10.1016/j.tins.2015.02.001
    [4] Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances[J]. Lancet, 2021, 397: 2082-2097. doi:  10.1016/S0140-6736(21)00393-7
    [5] Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)[J]. Pain, 2019, 160: 19-27. doi:  10.1097/j.pain.0000000000001384
    [6] Zheng YJ, Zhang TJ, Yang XQ, et al. A survey of chronic pain in China[J]. Libyan J Med, 2020, 15: 1730550. doi:  10.1080/19932820.2020.1730550
    [7] Hong JS, Wasden C, Han DH. Introduction of digital therapeutics[J]. Comput Methods Programs Biomed, 2021, 209: 106319. doi:  10.1016/j.cmpb.2021.106319
    [8] 徐宜蕙, 张一帆, 李杨, 等. 美国FDA批准的数字疗法产品临床试验设计研究[J]. 中国医学装备, 2022, 19: 1-7. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZB202211001.htm
    [9] Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects[J]. Pain Physician, 2008, 11: S105-S120.
    [10] Hagemeier NE. Introduction to the opioid epidemic: the economic burden on the healthcare system and impact on quality of life[J]. Am J Manag Care, 2018, 24: S200-S206.
    [11] Thurnheer SE, Gravestock I, Pichierri G, et al. Benefits of Mobile Apps in Pain Management: Systematic Review[J]. JMIR Mhealth Uhealth, 2018, 6: e11231. doi:  10.2196/11231
    [12] 罗尔丹, 白倩, 卞鹰, 成都市中老年慢性疼痛患者的治疗概况及移动医疗APP需求情况调查[J]. 临床医学研究与实践, 2021, 6: 10-13. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202115005.htm
    [13] Manini TM, Mendoza T, Battula M, et al. Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study[J]. JMIR Mhealth Uhealth, 2019, 7: e10044. doi:  10.2196/10044
    [14] Yang J, Weng L, Chen Z, et al. Development and Testing of a Mobile App for Pain Management Among Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial[J]. JMIR Mhealth Uhealth, 2019, 7: e12542. doi:  10.2196/12542
    [15] Lee J, Park SH, Ju JH, et al. Application of a real-time pain monitoring system in Korean fibromyalgia patients: A pilot study[J]. Int J Rheum Dis, 2019, 22: 934-939. doi:  10.1111/1756-185X.13472
    [16] Chen J, Abbod M, Shieh JS. Pain and Stress Detection Using Wearable Sensors and Devices-A Review[J]. Sensors (Basel), 2021, 21: 1030. doi:  10.3390/s21041030
    [17] Rosser BA, Eccleston C. Smartphone applications for pain management[J]. J Telemed Telecare, 2011, 17: 308-312. doi:  10.1258/jtt.2011.101102
    [18] Clement I, Lorenz A, Ulm B, et al. Implementing Systematically Collected User Feedback to Increase User Retention in a Mobile App for Self-Management of Low Back Pain: Retrospective Cohort Study[J]. JMIR Mhealth Uhealth, 2018, 6: e10422. doi:  10.2196/10422
    [19] Shaygan M, Jaberi A. The effect of a smartphone-based pain management application on pain intensity and quality of life in adolescents with chronic pain[J]. Sci Rep, 2021, 11: 6588. doi:  10.1038/s41598-021-86156-8
    [20] Blödt S, Pach D, Roll S, et al. Effectiveness of app-based relaxation for patients with chronic low back pain (Relaxback) and chronic neck pain (Relaxneck): study protocol for two randomized pragmatic trials[J]. Trials, 2014, 15: 490. doi:  10.1186/1745-6215-15-490
    [21] 林海玉, 郑珍丽, 陈伊文, 等. "互联网+"背景下采用"317护"APP对癌痛患者健康教育体会[J]. 中国农村卫生事业管理, 2018, 38: 771-773. doi:  10.3969/j.issn.1005-5916.2018.06.024
    [22] 阮兰红. 基于APP的放松疗法对慢性下腰痛患者情绪、疼痛和腰部功能的影响[J]. 颈腰痛杂志, 2022, 43: 37-40. https://www.cnki.com.cn/Article/CJFDTOTAL-JYTZ202201008.htm
    [23] Biebl JT, Rykala M, Strobel M, et al. App-Based Feedback for Rehabilitation Exercise Correction in Patients With Knee or Hip Osteoarthritis: Prospective Cohort Study[J]. J Med Internet Res, 2021, 23: 26658. doi:  10.2196/26658
    [24] Priebe JA, Haas KK, Moreno Sanchez LF, et al. Digital Treatment of Back Pain versus Standard of Care: The Cluster-Randomized Controlled Trial, Rise-uP[J]. J Pain Res, 2020, 13: 1823-1838. doi:  10.2147/JPR.S260761
    [25] Mahrer NE, Gold JI. The use of virtual reality for pain control: a review[J]. Curr Pain Headache Rep, 2009, 13: 100-109. doi:  10.1007/s11916-009-0019-8
    [26] Mazurek J, Kiper P, Cielik B, et al. Virtual reality in medicine: A brief overview and future research directions[J]. Hum Movement, 2019, 20: 16-22.
    [27] Bushnell MC, Case LK, Ceko M, et al. Effect of environment on the long-term consequences of chronic pain[J]. Pain, 2015, 156: S42-S49. doi:  10.1097/01.j.pain.0000460347.77341.bd
    [28] Macdonald G, Leary MR. Why does social exclusion hurt? The relationship between social and physical pain[J]. Psychol Bull, 2005, 131: 202-223. doi:  10.1037/0033-2909.131.2.202
    [29] Gold JI, Belmont KA, Thomas DA. The neurobiology of virtual reality pain attenuation[J]. Cyberpsychol Behav, 2007, 10: 536-544. doi:  10.1089/cpb.2007.9993
    [30] Hoffman HG, Doctor JN, Patterson DR, et al. Virtual reality as an adjunctive pain control during burn wound care in adolescent patients[J]. Pain, 2000, 85: 305-309. doi:  10.1016/S0304-3959(99)00275-4
    [31] Gupta A, Scott K, Dukewich M. Innovative Technology Using Virtual Reality in the Treatment of Pain: Does It Reduce Pain via Distraction, or Is There More to It?[J]. Pain Med, 2018, 19: 151-159. doi:  10.1093/pm/pnx109
    [32] Gromala D, Tong X, Choo A, et al. The Virtual Meditative Walk: Virtual Reality Therapy for Chronic Pain Management[C]. ACM CHI 2015. ACM, 2015. doi: 10.1145/2702123.2702344.
    [33] Hadjiat Y, Marchand S. Virtual Reality and the Mediation of Acute and Chronic Pain in Adult and Pediatric Populations: Research Developments[J]. Front Pain Res (Lausanne), 2022, 3: 840921. doi:  10.3389/fpain.2022.840921
    [34] 刘秋红. 基于虚拟现实的疼痛控制管理平台对行肝胆外科手术患者的干预效果[J]. 中西医结合护理, 2021, 7: 97-99. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXHL202109027.htm
    [35] 张宁宁, 陈艺. 虚拟现实技术结合音乐干预对烧伤患者创面换药时疼痛程度及心率、血压的影响[J]. 解放军护理杂志, 2020, 37: 78-80. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL202011021.htm
    [36] Lee HJ. Digital therapeutics in pain medicine[J]. Korean J Pain, 2021, 34: 247-249. doi:  10.3344/kjp.2021.34.3.247
    [37] 巩树伟, 刘爱峰, 郎爽, 等. 虚拟现实技术对慢性疼痛治疗的应用进展[J]. 中国疼痛医学杂志, 2020, 26: 438-442. https://www.cnki.com.cn/Article/CJFDTOTAL-ZTYZ202006011.htm
    [38] Rubin R. Virtual Reality Device Is Authorized to Relieve Back Pain[J]. JAMA, 2021, 326: 2354.
    [39] Mevleviolu D, Murphy D, Tabirca SM. Visual Respiratory Feedback in Virtual Reality Exposure Therapy: A Pilot Study[C]. ACM International Conference on Interactive Media Experiences. Association for Computing Machinery, 2021. doi: 10.1145/3452918.3458799.
    [40] Stamm O, Dahms R, Müller-Werdan U. Virtual reality in pain therapy: a requirements analysis for older adults with chronic back pain[J]. J Neuroeng Rehabil, 2020, 17: 129.
    [41] Dahlberg LE, Grahn D, Dahlberg JE, et al. A Web-Based Platform for Patients With Osteoarthritis of the Hip and Knee: A Pilot Study[J]. JMIR Res Protoc, 2016, 5: e115.
    [42] Lalloo C, Nishat F, Zempsky W, et al. Characterizing User Engagement With a Digital Intervention for Pain Self-management Among Youth With Sickle Cell Disease and Their Caregivers: Subanalysis of a Randomized Controlled Trial[J]. J Med Internet Res, 2022, 24: e40096.
    [43] Tick H, Nielsen A, Pelletier KR, et al. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper[J]. Explore (NY), 2018, 14: 177-211.
    [44] Bulaj G, Clark J, Ebrahimi M, et al. From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies[J]. Front Pharmacol, 2021, 12: 612602.
    [45] Metcalf CS, Huntsman M, Garcia G, et al. Music-Enhanced Analgesia and Antiseizure Activities in Animal Models of Pain and Epilepsy: Toward Preclinical Studies Supporting Development of Digital Therapeutics and Their Combinations With Pharmaceutical Drugs[J]. Front Neurol, 2019, 10: 277.
    [46] Lee JH. The Effects of Music on Pain: A Meta-Analysis[J]. J Music Ther, 2016, 53: 430-477.
    [47] Shebib R, Bailey JF, Smittenaar P, et al. Randomized controlled trial of a 12-week digital care program in improving low back pain[J]. NPJ Digit Med, 2019, 2: 1.
    [48] Huber S, Priebe JA, Baumann KM, et al. Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results[J]. JMIR Rehabil Assist Technol, 2017, 4: e11.
    [49] van der Vaart R, van Driel D, Pronk K, et al. The Role of Age, Education, and Digital Health Literacy in the Usability of Internet-Based Cognitive Behavioral Therapy for Chronic Pain: Mixed Methods Study[J]. JMIR Form Res, 2019, 3: e12883.
    [50] Griffiths C, Foster G, Ramsay J, et al. How effective are expert patient (lay led) education programmes for chronic disease?[J]. BMJ, 2007, 334: 1254-1256.
    [51] 陈玮. 智能手机使用对医学生颈痛影响的调查研究[D]. 青岛: 青岛大学, 2019.
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出版历程
  • 收稿日期:  2023-02-16
  • 录用日期:  2023-04-13
  • 刊出日期:  2023-09-30

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