Electronic diaries as a tool to improve pain management: is there any evidence?

Chronic pain is a common and costly syndrome which affects approximately one in three US adults. Factors such as shortened length of the medical visit, increased availability of technological approaches to care, and a more informed patient all suggest that a new paradigm is required for chronic pain management. Although much has been written about the use of electronic diaries in clinical trials, little has been presented about the use of these diaries in clinic practice and their potential for changing pain behavior. The intent of this preliminary study is to measure accessibility and usability of a software program designed for use on a personal digital assistant and to discuss how the software program may impact clinic practice and patient behavior.

We present the results of a preliminary, randomized, comparison, crossover trial of 36 chronic pain patients who were asked to monitor their pain, mood, activity interference, medication use, and pain location on either a paper or electronic diary for 2 weeks. Patients in the electronic diary condition were able to observe changes in their ratings over time and view them on a secure web site.

No differences were found between paper and electronic tracking on pain descriptors, pain interference, mood, or helpfulness of medication. Similar to past findings, patients found the electronic diary easier to use (P < 0.0001) and would continue using it (P < 0.05) over paper if given the choice. Importantly, patients using the electronic diary reported more frequently that a provider suggested medication change (P < 0.05) based on feedback from the electronic diary. One trend requiring further investigation is that electronic diary users reported that the diary enabled them and their doctor to make care adjustments according to changes in pain status.

This study goes beyond previous research on preference and data quality to investigate how the information provided may affect patient and physician perspectives toward pain management. Although not the initial intent of this study, findings indicate that electronic tracking may provide information which can affect management decisions. A follow-up study is ongoing to investigate these initial results. If found to be true, electronic monitoring may have broad implications for health care, policy, and improvement in quality of care for chronic pain sufferers in the future.