Chronic pain conditions are difficult to cure. It requires constant self-management of the biopsychosocial consequences.
Table of Content
|1.||What is eHealth?|
|2.||The ten “E’s” in “eHealth”|
|3.||eHealth for chronic pain management|
|4.||Features eHealth tools|
What is eHealth?
eHealth is the utilization of information and communication technologies (ICT) in healthcare. It is an emerging field in the delivery of health services and information through the internet and related technologies. It is easily available, perceived as neutral and nonjudgemental, and allows you to continue treatment at your own pace.
Also, eHealth interventions reduce the need for travel and direct health care personnel involvement. It may also enhance treatment durability, as you can receive support and reinforcement of skills during and after treatment.
In addition to technical development, eHealth also characterizes an attitude, a way of thinking, a state-of-mind, and a commitment for a networked, global mindset, to enhance healthcare locally, regionally, and worldwide by using ICT.
As such, the “e” in eHealth stands not only for “electronic,” but implies the other 10 “e’s,” which together perhaps best characterize eHealth.
The ten “E’s” in “eHealth”
One of the capabilities of eHealth is to enhance efficiency in healthcare, thereby reducing costs. One possible way of reducing costs would be by avoiding unnecessary or duplicative diagnostic or therapeutic interventions, via enhanced communication possibilities between health care services, and via patient involvement.
2. Enhancing the quality of care
Increasing efficiency involves reducing costs while improving quality at the same time. eHealth may enhance the quality of health care, for instance, by allowing comparisons between different providers, directing patients to the best quality providers, and involving consumers as additional power for quality assurance.
eHealth interventions should be evidence-based in the sense that their efficiency and effectiveness should not be assumed but validated by rigorous scientific investigation.
4. Empowerment of consumers and patients
By making the knowledge bases of personal and medical electronic records accessible over the internet, eHealth opens new avenues for personalized medicine and enables evidence-based patient choice.
5. Encouragement of patient-doctor relationship
Patients and healthcare professionals should have a relationship and a true partnership, where decisions are achieved in a shared manner.
Consumers and physicians can be educated via online sources to improve medical knowledge.
7. Enabling information exchange and communication
Communication and information exchange can be enabled in a standardized way between health care services.
8. Extending the scope of healthcare beyond conventional boundaries
Extend the scope of health care, both geographically and conceptually. eHealth enables consumers to obtain health services online from global providers readily. These services range from simple advice to more complex interventions.
eHealth involves new types of patient-physician interaction and poses new challenges and threats to ethical issues such as informed consent, online professional practice, privacy, and equity issues.
eHealth promises to make healthcare more equitable. However, at the same time, there is a significant threat that eHealth may widen the gap between the “haves” and “have-nots.” People who have less money, skills, and access to computers and the internet cannot go online effectively. As a result, these patient populations are those who are the least likely to benefit from eHealth, unless political measures ensure equitable access for everyone. The digital divide current runs between rich vs. poor population, rural vs. urban, young vs. old, and between neglected/rare vs. common diseases.
eHealth for chronic pain management
eHealth interventions can help you cope with chronic pain. It is well-positioned to address treatment barriers such as transportation, cost, time constraints, knowledge of existing web-based health resources, and both patient and provider access to these resources. It may provide short- and intermediate-term improvement in pain intensity.
Accessible healthcare for older and underserved populations
eHealth has the potential to supplement in-person home visits for older, rural adults with chronic pain. The rapidly increasing use of the internet by older patients and the growing presence of patient portals offer expanding opportunities to deliver web-based behavioral treatments for pain. Older, adult-specific web-based treatment tools are quickly becoming commonplace.
Stepped-care systems for pain management
Formal stepped-care systems of pain management can be developed using eHealth interventions. eHealth is more accessible and cost-effective than stepped-up intensive face-to-face pain management interventions. Moreover, this approach involves undertaking a group-based knowledge and skills program before seeking medical care.
The intervention should use easily understandable language, with short and to-the-point sections made accessible on small screens and mobile phones, to meet acceptability and usability for the target group.
Intuitive and useful functionalities
The eHealth system should also have intuitive and useful functionalities that do not demand too much of your time. This gives you more options to choose from, as well as automatic suggestions adjusted to your needs.
Design features to support motivation and usage
Motivation to continue and complete the use of an eHealth intervention is crucial to obtain a therapeutic effect. Usability, accessibility, reliability, and personalization are essential facilitators for adherence. Guided interventions can also reduce attrition rates.
Developing a consumer-enabled eHealth system
Eliciting user preference in the development of eHealth interventions may be an essential step toward developing meaningful interventions to manage chronic pain. Using user-centered designs can allow for tailoring of individual preferences and personalization to improve impact and help maintain patient focus.
Features eHealth tools
Strong cross-sector engagement is a cornerstone of successful eHealth implementation.
A one-stop web-based patient portal
Web-based portals allow you to access your personal health information such as laboratory results, upcoming appointments, and medication information. Additionally, you can use portals for bidirectional communication with your primary care providers about your health status and treatments.
Clinical informatics should be leveraged to deliver evidence-based, nonpharmacological treatment information. It should build your knowledge of various pain treatments and direct you to the existing digital therapeutics tools.
Online one-to-one remote coaching
Internet-delivered coaching provides a system for learning about pain and self-management skills. These interventions often employ the same principles, provide the same information, and teach the same self-management skills as face-to-face interventions.
However, the online system is carefully designed to be provided through the internet without the need for face-to-face contact. Therefore, it bypasses geographic or socio-demographic care disparities often associated with conventional face-to-face models of intervention.
Remote internet-delivered coaching aims to:
- Provide information that helps you to make sense of pain
- Teach evidence-based cognitive and behavioral skills (thought challenging, de-arousal strategies, activity scheduling, activity pacing, graded exposure)
- Reduce pain-related disability, anxiety, and depression by supporting the adoption of evidence-based skills taught within the program
Behavioral and psychological interventions
eHealth interventions should accommodate your varying pain levels, your challenges with feeling guilty of never doing enough, and your concentration issues.
Hence, you should be given positive input in your daily lives through a solution that provides you with practical and personalized advice on pain management. The solution should fit into your existing everyday routines, giving you a break, positive input, and reminders in your daily lives. In contrast, the intervention should not focus on the negative aspects of living with chronic pain. It also should not provide you with too much information or too much choice, flashy graphics such as sound and animation effects, or cumbersome log-in procedures.
Cognitive-behavioral therapy (CBT) and acceptance commitment therapy (ACT) are examples of successful psychological interventions for chronic pain. The interventions are effective in improving quality of life, depressive symptoms, and pain acceptance. Importantly web-based behavioral treatments for pain have demonstrated efficacy.
Electronic pain diary
The eHealth tool should also have a diary function to increase your awareness of how your everyday life is affected by:
- Daily activities
- Pain level
- Mood level
From a CBT standpoint, this could be viewed as useful, as increasing your awareness and ability to take an active part in your own life is crucial. Electronic registrations and notes can also support you in keeping a more up-to-date diary, instead of one based on recollection.
However, too much focus on the pain itself, for instance, through keeping a pain diary, can be detrimental and could increase pain interference.
Practical resource library
Information and content should be trustworthy. Yet, you should not be receiving too much information, especially when you already know a lot about pain and the theory behind pain management. Instead, you should be given practical and quick exercises that could help you in your daily lives.
Learning management skills and obtaining knowledge online could be an accessible way for you to gain knowledge. This may provide you with a constant option you could use at your own preferred time and space, allowing for self-direct recurrent exposure to the information and making the process inure. In that sense, eHealth interventions could strengthen the potentially fading impact on CBT on pain and function.
Self-management support can help to decrease pain interference and pain intensity.
You will be empowered to have more influence over your health by enabling your ability to gain control over self-defined important matters, thus leading to better self-management. As such, you will become more knowledgeable and, at the same time, become more empowered and independent.
Patient decision aids
Patient decision aids are evidence-based tools curated to help you choose between several management options. It allows you to personalize information about treatment effectiveness, outcomes, and the inherent uncertainties of potential benefits versus potential harm.
The program includes an information module illustrating the benefits and side effects of various medications, a preference elicitation module facilitating you to consider the pros and cons of using particular medicine, and a set of health questionnaires.
It reduces your decisional conflict (i.e., the feeling of uncertainty and being unsupported while making a treatment decision) and improves your medication knowledge.
Online peer support community portal
Social platforms such as Facebook have given rise to a growing number of online patient peer-to-peer support communities. Here, you can connect to sources and share information, and offer each other support. Engagement in such an environment fosters positivity, emotional expression, and support.
Management of chronic pain offers excellent potential for eHealth through increased participation, flexibility, autonomy, and mobile self-management. This is evident with the shift towards interactive and engaging self-management applications that provides you the ability to track pain and activity in one convenient portal.