How DiGAs can support pain therapy: Pain-free in the virtual world

20.10.2023 11:44

Chronic or frequently recurring pain demands a lot from those affected: it impairs the quality of life and often limits social life and professional performance. Early and competent treatment would be correspondingly important - but there is currently a serious shortage of therapy places, especially in the psychotherapeutic area. How digital and innovative applications can help close this gap in care is a key topic at this year's pain congress of the German Pain Society and the German Head and Migraine Society (DMKG), which will take place in Mannheim from October 18th to 21st, 2023.

According to various estimates, at least 20 to 30 percent of the population in Europe is affected by chronic pain. In addition to the individual burden, the suffering also has great social and economic significance. Pain is described as chronic if it occurs either with high frequency over at least three months without any noticeable physical damage - as is often the case with chronic headaches or migraines - or if it lasts significantly longer than due to a previous acute injury or illness would be explainable. “The pain has virtually taken on a life of its own and is decoupled from physical causes,” says private lecturer Dr. med. Lars Neeb, specialist in neurology and medical director of Helios Global Health and this year's congress president.

DiGAs could help close supply gaps

A central element in the treatment of chronic pain is multimodal pain therapy, which, in addition to medication, also includes exercise, relaxation therapies and cognitive behavioral therapy to manage pain. “However, there are major gaps in supply here,” says Professor Dr. Axel Schäfer, Professor of Therapy Research and Physiotherapist at the University of Applied Science and Art in Hildesheim. DiGAs could help close these gaps and support outpatient therapy. The digital possibilities are diverse and their effectiveness is increasingly well documented. Schäfer cites virtual reality (VR) as an example, to which he is dedicating a separate symposium at the congress. The illusion of a virtual body that acts in an artificial world is created using VR glasses. On the one hand, this effectively distracts from the pain. “On the other hand, the user can completely immerse themselves in the virtual environment and, ideally, experience the virtual body as really present,” says Schäfer. This phenomenon is referred to as embodiment and is discussed as one of the possible mechanisms of action of VR in pain therapy. Because the illusion of a virtual body also changes the perception of body and pain in the real world. In recent years, VR has become increasingly important in the treatment of chronic pain.

Support outpatient therapy with apps

A small but significant pain-reducing effect can also be achieved using specially developed smartphone apps. Eleven such apps for the indication area of pain have now been recognized by the Federal Institute for Drugs and Medical Devices (BfArM) and listed as reimbursable DiGAs. “They usually include elements such as stress reduction, relaxation, sleep hygiene, nutrition or a pain diary,” summarizes Schäfer. The apps could thus support outpatient therapy and help to transfer what has been achieved into everyday life.

Make better use of the therapeutic potential of digitalization

Last but not least, telemedicine can also help to improve the care of pain patients and make them location-independent. “The therapeutic potential of digitalization is far from exhausted and can only be roughly estimated so far,” says Congress President PD Dr. med. Lars Neeb. However, given the rapid development and lack of long-term data, many questions remain unanswered. Future research on the topic must not only evaluate the therapeutic effects more closely and identify patient groups that benefit differently from the DiGAs. You also have to deal with what hurdles exist when using them and how you can specifically address and involve patients who have previously had little affinity for digital media and support them in using these applications. Other questions concern cultural differences, ethical concerns, data protection, but also the experiences that healthcare professionals have with the DiGAs.

Digitalization must never become an end in itself

The DiGAs themselves also offer the opportunity to collect previously inaccessible data and thus contribute to research into chronic pain phenomena. In this context, Neeb refers to the DMKG's migraine and cluster headache apps, which enable the app data to be linked anonymously to the DMKG's headache register. This would provide real-world data that could be used to answer many questions more quickly and easily than before - such as the question of the effectiveness and possible side effects of migraine medications. This knowledge would ultimately benefit those affected. “We must never lose sight of one thing,” says Neeb, “digitalization must never become an end in itself, but must always remain oriented towards patient well-being and be integrated into treatment concepts. They can support the treatment, but cannot replace direct doctor/therapist contact with the patient.”