Systematic Evaluation of Commercially Available Pain Management Apps Examining Behaviour Change Techniques

Kaitlyn L. Gamwell; Sophie R. Kollin; Robert C. Gibler; Helen Bedree; Keely H. Bieniak; Anjana Jagpal; Susan T. Tran; Kevin A. Hommel; Rachelle R. Ramsey


Pain. 2021;162(3):856-865. 

In This Article

Abstract and Introduction


Mobile health (mHealth) apps have the potential to enhance pain management through the use of daily diaries, medication and appointment reminders, education, and facilitating communication between patients and providers. Although many pain management apps exist, the extent to which these apps use evidence-based behavior change techniques (BCTs) remains largely unknown, making it nearly impossible for providers to recommend apps with evidence-based strategies. This study systematically evaluated commercially available pain management apps for evidence-based BCTs and app quality. Pain management apps were identified using the search terms "pain" and "pain management" in the App and Google Play stores. Reviewed apps were specific to pain management, in English, for patients, and free. A total of 28 apps were coded using the taxonomy of BCTs. App quality was assessed using the Mobile App Rating Scale. Apps included 2 to 15 BCTs (M = 7.36) and 1 to 8 (M = 4.21) pain management–specific BCTs. Prompt intention formation, instruction, behavioral-health link, consequences, feedback, and self-monitoring were the most common BCTs used in the reviewed apps. App quality from the Mobile App Rating Scale ranged from 2.27 to 4.54 (M = 3.65) out of a possible 5, with higher scores indicating better quality. PainScale followed by Migraine Buddy demonstrated the highest number of overall and pain management BCTs as well as good quality scores. Although existing apps should be assessed through randomized controlled trials and future apps should include capabilities for electronic medical record integration, current pain management apps often use evidence-based pain management BCTs.


As outlined by the Pain Management Best Practices Inter-Agency Task Force,[18] treatment of chronic pain should adhere to a biopsychosocial multimodal approach. Effective management of pain typically includes psychoeducation, symptom monitoring, identification of triggers and relief, and adherence to pharmacological and nonpharmacological treatment recommendations (eg, restorative, behavioral, and complimentary and integrative health therapies).[4,18,25] However, obtaining optimal pain management support and skills training during face-to-face medical appointments may not be feasible because of time, cost, insurance coverage, and demand constraints.[8,20,24] Technology-based interventions for pain management are an effective way to provide self-management skills in light of these constraints.[7,9,10,28,30] Furthermore, patients and providers are increasingly using mobile health (mHealth) apps to provide both education and self-management skills. Although thousands of mHealth apps related to pain management are available, there is no published guidance for healthcare providers on how to identify and recommend commercially available, user-friendly, evidence-based pain management apps.[5,14]

Several reviews before 2017 concluded that pain management apps were overly simplistic, lacked provider insight in the development, and had not been rigorously tested.[14,15,22] The mHealth landscape has significantly changed since these reviews and, although apps continue to need rigorous efficacy testing, systematic guidance regarding the selection of mHealth apps that include evidence-based strategies is a critical need. Systematically reviewing apps using the taxonomy of behavior change techniques (BCTs) provides a structure to reliably identify operationalized, theory-derived BCTs used in interventions such as self-monitoring, specific goal setting, stress management, and instruction (see Ref. 1 for full list). The BCT taxonomy has been used to assess and develop face-to-face behavioral health interventions for a variety of pain populations[11,17] and has successfully been adapted to specifically assess BCTs in mHealth interventions.[12,21] Thus, as patients and providers are increasingly turning to health technology to support pain management, there is a critical need to understand the extent to which evidence-based behavior change strategies have been translated to available pain management apps.

The current study sought to address this gap in the extant literature by evaluating the presence of evidence-based BCTs in commercially available pain management apps and their quality. Specifically, the aims of this study are to (1) systematically evaluate the content of free, publicly available pain management apps using Abraham and Michie's theory-driven taxonomy of BCTs[1] to assess the presence of overall BCTs and pain management–specific BCTs; (2) evaluate the quality of pain management apps using a validated rating system (Mobile Application Rating Scale [MARS[26]]); and (3) provide recommendations for providers and patients based on the presence of evidence-based BCTs and usability.