Effectiveness of telemedicine to the management of chronic pain : a systematic review

Abstract

Background: Chronic pain, practically defined as persistent pain for more than three months, is experienced by 34.9% of the population in Hong Kong according to a local survey. Due to various limitations in the existing pain management and increasing service demand, under-treatment of chronic pain patients is well documented. Telemedicine is currently under active research has a cost-effective way to enhance service accessibility for chronic pain management and has been implemented in some western countries. The objectives of this study are to investigate the effectiveness of telemedicine to the management of chronic pain, compare it with conventional care and find out the implications for implementation through reviewing the latest literatures.

Methods: Literature search through electronic database was conducted to locate randomized controlled trials (RCTs) which carried out from year 2004 to year 2014 and primarily investigated the effectiveness or efficacy of telemedicine on chronic pain of all kinds. Outcome measures including pain intensity, pain catastrophizing, self-efficacy, physical functioning and patient satisfaction are extracted for in-depth study.

Findings: 10 RCTs were selected for this systematic review. All studies involved either internet or telephone as the telecommunication tool for treatment. All included studies showed beneficial effect of telemedicine to at least one condition commonly experienced by chronic pain patients. While consistent findings were found for the improvement of pain catastrophizing and self-efficacy, limited yet promising effect was found for pain intensity and physical functioning. From the studies using usual care control group, the potential superiority of telemedicine over the conventional care in chronic pain management was also revealed. Study participates were generally satisfied with telemedicine and found it as useful.

Conclusions: This study presented promising results on the effectiveness of telemedicine to the management of chronic pain. It also revealed the potential superiority of telemedicine over conventional care in terms of treatment effect and patient’s experience. To further assess the application of telemedicine to chronic pain, analysis on cost and treatment methodology were suggested.