Pain Coach by VA

Chronic pain is one of the most prevalent, costly, and debilitating conditions in the United States (Gaskin & Richards, 2012; Yong et al., 2022). Given the myriad potential barriers patients face when seeking treatment for chronic pain (e.g., economic burdens, lack of transportation, childcare concerns, shortage of specialists; Baker et al., 2024), mobile apps show great promise for improving access to evidence-based chronic pain management tools. Pain Coach is a new, free mobile app for chronic pain management developed by the Mobile Apps Team at the National Center for PTSD (NCPTSD) at the VA Palo Alto Health Care System. The app is one of several publicly available mobile apps (e.g., PTSD Coach, CBT-i Coach, Stay Quit Coach) developed through the NCPTSD within the Department of Veterans Affairs (McGee-Vinvent, 2021). The Pain SIG sat down with Dr. Jennifer Murphy, Director of Pain Management for the Department of Veterans Affairs, and Dr. Katherine Taylor, health psychologist and member of the Mobile Apps Team at the NCPTSD to learn more about this resource and the ways in which it can support providers' work with chronic pain patients. The Pain Coach app was developed to promote self-management of pain, improve daily functioning, and maximize quality of life. Although veterans are disproportionately affected by chronic pain (Nahin, 2017; Zelaya et al., 2020), this app was designed for all individuals with chronic pain, Dr. Murphy said. While reports on the app's development and outcomes are currently in progress, the app pulls from evidence-based treatments such as Cognitive Behavioral Therapy for Chronic Pain (CBT-CP; Ehde et al., 2014; Murphy et al., 2022) and Acceptance and Commitment Therapy (ACT; McCracken & Vowles, 2014) to provide patients with tools and strategies accessible enough for self-guided use. However, Dr. Murphy also noted that using Pain Coach in collaboration with a healthcare provider is likely going to enhance the use of the app and is therefore recommended whenever possible. For example, the app can complement psychotherapy for pain management by offering a convenient way for patients to track their progress, practice the skills they learned in sessions, and set reminders for completing homework assignments. Clinicians have found it to be a valuable tool for enhancing treatment adherence and reinforcing skill practice between sessions. In addition to its clinical benefit, the Pain Coach app is a valuable resource for researchers who are interested in studying the potential benefits of a mobile app as an adjunct or standalone treatment for chronic pain. The Pain Coach developers are eager to hear from researchers who collect data on the app's use. Pain Coach includes several easy-to-use features that patients can access from their mobile device: Daily check-ins to track emotions, use of pain management strategies, and engagement in values-directed activities Self-assessments (e.g., Pain Catastrophizing Scale, Patient Health Questionnaire) that can be exported and shared with a provider to monitor progress Simple educational material to provide clear information on what chronic pain is, how it differs from acute pain, and how self-management tools can help Numerous interactive, evidence-based tools (e.g., pleasant activities, deep breathing and relaxation, emotion regulation strategies, self-compassion meditations, sleep hygiene recommendations, cognitive challenging techniques) Step-by-step support in establishing an individualized "Pain Support Network" Journal prompts with multiple modalities (e.g., text, image, video, drawing) for documenting thoughts and emotions Optional reminders to complete daily check-ins, self-assessments, and journal entries Importantly, Dr. Taylor emphasized that Pain Coach is free, publicly available to anyone, and private, which makes it a great option for researchers and clinicians alike. There is no login email and no information sharing. All data pulled from the app is completely anonymous (e.g., # of times a button was tapped). Ways to incorporate Pain Coach with your patients: Encourage patients to practice the skills they learned in sessions at home with the support of the Pain Coach app. Recommend patients track their symptoms in-between sessions with the self-assessment tools to monitor progress. If your clinic is experiencing long wait times for patients to see a provider, consider recommending Pain Coach as an introduction to pain self-management tools while patients wait to be scheduled with a provider. Encourage patients to use Pain Coach after completing treatment to maintain treatment gains.

Background: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1%). These veterans received our outreach program; 236 (236/393, 60.1%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2% (24/236) used Pain Coach, and 58% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3%). Conclusions: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study.