Kudos to Sophia Smith, her Co-PI, Eric Elbogen and their entire team for the submission of their NIH R21 application entitled “Integrating Technological Approaches for Pain Management in Cancer Patients.” This proposal requests funding for a two-year period with a start date of Sept. 1, 2018.

Cancer patients frequently suffer from severe chronic pain resulting from curative therapies and disease progression. Pain experienced by cancer patients is also associated with symptoms of posttraumatic stress disorder (PTSD). Although it is critical to treat chronic pain effectively in cancer patients, pharmacological treatments present increased risk of opioid abuse and adverse clinical outcomes. To compound these challenges, patients with chronic pain and PTSD are also more vulnerable to negative outcomes associated with pain medication. While non-pharmacologic therapies such as cognitive behavioral therapy (CBT), neurofeedback and other clinic-based treatments have been found effective in treating pain symptoms, they are often unavailable or difficult for patients to access. Mobile health technology offers a platform for pain management that is cost-effective, accessible and reduce these barriers to care.

A growing body of evidence suggests that pain and PTSD symptoms in cancer patients can be effectively managed via mobile technology. Our research group has shown that a CBT-based mobile app (Cancer Distress Coach) reduces PTSD in cancer patients and that a mobile neurofeedback app to regulate brain waves and facilitate a relaxed physiological state leads to reduced pain intensity in chronic pain patients. This application combines these two into a single Integrated Pain Management (IPM) mobile app and offers a comprehensive approach to reducing pain and PTSD symptoms. This project will develop and test the usability, feasibility and initial effectiveness of IPM to reduce pain among solid tumor cancer patients. We will examine usability of IPM among a sample of N=10 solid tumor cancer patients with moderate to severe chronic pain. Data will include observation of patient use as well as patient feedback through interviews and surveys.

We will then seek to define feasibility of IPM using a one group, pre-post study design among N=30 solid tumor cancer patients. Participants will be encouraged to use multiple components of CBT and asked to engage in mobile neurofeedback on the IPM app at least four times a week for three months. Feasibility will be assessed by analyzing data collected from measures of pain outcomes and PTSD symptoms administered at baseline (pre) and at three-months (post) as well as by participant usage collected within the IPM app.

This project will be the first to test the efficacy of such interventions in a population of cancer patients with chronic pain. Findings from this study have potential to improve pain and other clinical outcomes such as PTSD symptoms among cancer patients using CBT and neurofeedback delivered via mobile technology. And, this study addresses one of the ten National Cancer Moonshot recommendations – symptom management – in a manner that reduces barriers to access, particularly among underserved populations. In summary, the IPM app will offer cost-effective self-management strategy for pain management, enhanced access to care, and reduced risk of side effects associated with traditional, pharmacological interventions