Initial testing of a mobile app behavioral pain coping intervention for patients with cancer: Results of a pilot...

Behavioral management is recommended for cancer pain, yet not well integrated into clinical practice. PainPac is an asynchronous mobile application that delivers behavioral pain coping strategies. We evaluated PainPac's feasibility, acceptability, and impact on pain compared to a videoconference-delivered protocol (PCST-Video).

Participants (N = 62) were adults with a stage I-IV diagnosis of colorectal cancer within the past two years and pain ≥4 on 0-10 scale from an academic cancer center. Participants were randomized 1:1 to PainPac or PCST-Video. Feasibility (accrual [N = 60/15 months]; attrition at the post-treatment assessment [primary endpoint; <25%]; adherence to all assessments and intervention modules/sessions [>75%]), burden (number of modules/sessions completed; time from baseline to completion of first module/session; time to complete all sessions/modules), engagement (skills practice and PainPac log in >3 times/week), and acceptability (≥80% of participants reporting ≥75% satisfaction on Client Satisfaction Questionnaire) were assessed. Changes in pain and pain-related outcomes were explored at baseline (A1), post-treatment (A2), and 1-month post-treatment (A3).

Feasibility exceeded prespecified benchmarks (N = 62/10 months; 92% A2 retention). Ninety percent of PainPac participants completed all modules (M_sessions=3.77, SD=.82); 80% of PCST-Video participants completed all sessions (M_sessions=3.37, SD = 1.33). Participants moved from A1 to completion of first module/session in 1 day for PainPac and 12 days for PCST-Video. Number of days to complete all modules/sessions was M = 23.57 (SD = 5.31) for PainPac and M = 27.63 (SD = 6.70) for PCST-Video. PainPac engagement exceeded prespecified benchmarks (M = 9.22 app logins per week). Satisfaction was high with PainPac (89.3% ≥24; M = 28.11, SD = 3.74) and PCST-Video (92.6% ≥24; M = 28.93, SD = 3.57). Pain outcomes changed in the expected direction for both conditions, improving from A1 to A3.

PainPac is a promising approach for improving cancer pain management. Technology-based behavioral interventions can decrease barriers and improve intervention reach, scalability, and sustainability in clinical practice. Larger, well-powered randomized trials are needed to test PainPac's efficacy.

ClinicalTrials.gov, NCT05686122.