key: cord-1020208-veug3dae authors: Weiling, Lydia Li; Ming Kai, Alton Chew; Gunasekeran, Dinesh Visva title: Digital health for patients with chronic pain during the COVID-19 pandemic date: 2020-08-10 journal: Br J Anaesth DOI: 10.1016/j.bja.2020.08.003 sha: aa3b749db51cf649a240e2e38547d0f7e1a35c7c doc_id: 1020208 cord_uid: veug3dae nan Chronic pain is an increasingly prevalent medical problem affecting over a third of some 32 populations. 3 It is the leading cause of disability globally, increases economic vulnerability, 33 has a detrimental impact on quality of life (QoL), and is commonly associated with both 34 anxiety and mood disorders. 4 Telehealth is a form of digital health that promises to provide the much-needed supporting 54 infrastructure for care continuity in the context of the pandemic. Traditional non-digital 55 telehealth mediated by interventions such as nurse-led telephone calls have been described 56 with encouraging results such as in the SCOPE trial. 9 New national policy shifts are now 57 enabling rapid adoption of digital telehealth to provide more scalable responses to the 58 pandemic, 10 with recent reviews of potential applications and clinical practice 59 recommendations for teleconsultation in chronic pain patients. 11,12 However, these linear 60 platforms have a long history of failed experiments, largely as a result of underestimated 61 resource and manpower capacity required for successful deployment of telehealth services. 13 62 Therein lies the importance of considering the form of service delivery in detail in addition to 63 the forms of technology. 64 The most suitable form of service delivery may vary for each practice based on numerous 66 considerations such as manpower availability, infrastructure, and existing workflows in the 67 intended clinical setting. The form of telehealth delivery also needs to be considered, whether 68 asynchronous with "store-and-forward" mechanisms, synchronous with real-time scheduled 69 or "on-demand" consultations, or both. 14 These considerations can be incorporated together 70 in a well-planned study using approaches such as design thinking, 15 Many of these chat bots function as promising forms of asynchronous telehealth for advice to 116 out of hospital patients. This helps to filter patients that primarily require reassurance or 117 advice, from those who may need further synchronous video consultations or in-person 118 review. This "sorting conveyor" model is beneficial to leverage digital solutions to address 119 the needs of patients and reduce unnecessary healthcare presentations, thereby helping to 120 reduce risks of healthcare associated transmission of COVID-19. 16 That said, a recent review 121 reported that most healthcare applications of chat bots lack sufficient validation of clinical 122 outcomes. 25 This is a crucial step that is needed for these solutions to be safely deployed. 26 123 Therefore, while these solutions may be useful to scale-up patient support for mental health 124 and self-management, any deployed solutions should be closely monitored for performance. particularly for applications of surveillance technology whereby patients do not "opt in" for 154 the service, such as big data monitoring or contact tracing systems. Given the urgency of the 155 current pandemic situation, providers will likely find these digital health solutions useful to 156 address misinformation, provide support, and maintain continuity of care for their patients. 157 However, clinicians will also need to consider the forms of solutions and service delivery in 158 order to ensure successful application of these digital tools. 159 Coronavirus disease (COVID-2019) situation The Untold Toll -The Pandemic's Effects on Patients without 190 Prevalence of chronic pain 193 in the UK: a systematic review and meta-analysis of population studies Chronic pain: a review of its epidemiology and 196 associated factors in population-based studies The economic impact of 198 chronic pain in adolescence: methodological considerations and a preliminary costs-199 of-illness study Covid-19: risk factors for severe disease and death The Mental Health Consequences of COVID-19 and 203 Physical Distancing: The Need for Prevention and Early Intervention Chronic pain after COVID-19: implications for 206 rehabilitation Telecare collaborative 208 management of chronic pain in primary care: a randomized clinical trial COVID-19 transforms health care 211 through telemedicine: evidence from the field Managing patients with chronic pain during 214 the COVID-19 outbreak: considerations for the rapid introduction of remotely 215 supported (eHealth) pain management services Telemedicine for chronic pain management during 217 COVID-19 pandemic Video consultations for covid-19. 219 Next generation telemedicine 221 platforms to screen and triage Technology and chronic disease management Safety and Efficacy of Follow-up for Patients 225 With Abdominal Pain Using Video Consultation: Randomized Controlled Trial 226 Evaluating Digital Telereview Online Health Communities to Deliver Patient-Centered Care to People With Chronic 229 Conditions The role of online support communities: benefits of 231 expanded social networks to patients with psoriasis Online support groups gaining credibility Delivering Cognitive Behavior Therapy to 238 Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated 239 Conversational Agent (Woebot): A Randomized Controlled Trial A fully automated conversational agent for promoting 242 mental well-being: A pilot RCT using mixed methods GP at hand: a digital revolution for health care provision? Health Care Chatbot to Promote Self-Management of Chronic Pain (SELMA): Pilot 247 Randomized Controlled Trial Gunasekeran DV. Regulations for the development of deep technology 252 applications in healthcare urgently needed to prevent abuse of vulnerable 253 patients Patient-reported improvements in health 255 are maintained 2 years after completing a short course of cognitive behaviour therapy