Here’s another top article from this year, written by our global health expert, Dr Ortego…
SPAIN – Dr Rocio Ortego Delgado, Global Health Expert, talks with Dr Ernesto Martinez Garcia, creator of the PainAPPle® app. The innovative tool has huge potential for supporting acute pain management in children.
I had the pleasure to meet Dr Ernesto Martinez Garcia and be trained by him in 2009 during residency. I could see at that moment not only his professionalism, but also, the human being behind the scrubs. He was a consultant in 2009, and due to his hard work, his research and management skills, he became Head of the Anaesthesiology Department at Niño Jesus Hospital in Madrid, Spain in 2015.
He has been working for a few years in his PhD at the Paediatric Department of the University Autonoma of Madrid on surgical acute pain assessment in children. As a result, he developed a validated tool for paediatric pain evaluation together with an application to obtain data about pain management and its side effects. It has the potential to be very useful to individualise and balance treatment, as well as to continue research to improve pain management.
(Dr Martinez Garcia is the head of the Department of paediatric anaesthesiology at Niño Jesus University Hospital in Madrid. Spain. Photograph offered by Niño Jesus Hospital)
Pain management is a hot issue[i], due to the importance to relieve pain worldwide, but also, considering the secondary effects[ii],[iii] that the use of opioids and opioid-like may produce. The World Health organisation (WHO) takes very seriously concerns raised recently about the development of its 2011 and 2012 guidance for pain management. WHO is discontinuing these guidelines in light of new scientific evidence that has emerged since the time of their publication. This will also address any issues of conflicts of interest of the experts that have been raised.[iv]
In this same note (20 June 2019), WHO also recognises that the need for access to pain relief must be balanced with concerns about the harm arising from the misuse of medications prescribed for the management of pain, including opioids. Scientific evidence indicates there are risks associated with the use of these medications —such as the development of dependence, overdose and accidental death. Even when prescribed according to established clinical guidelines and patients’ needs, and used as directed, certain factors may increase these risks.
New technologies like Dr Garcia’s application for pain management, together with the exponential development of artificial intelligence, is helpings care givers and patients[v] monitor and individualise drug doses.
Here’s a brief description of this innovation:
PainAPPle® APP is a validated tool through which children participation allows care givers to asses and treat acute pain continuously. It is a tool made to manage an Acute Pain Unit based on quality indicators and may be used to implement a Quality Management model of a ‘pain free Hospital’ as the world health organisation promotes.
PainAPPle® was developed through a collaboration with Whitestone Technology S.L. and it contains scales to asses pain in children according to their age: for children under four who – or who cannot – collaborate ‘observational scales’ (FLACC, LLANTO), and digital scales for those over four years (EVA, Wong-Baker-Faces). It also has side effects scales for vomiting and nausea, sedation, itch, motor block and urine retention. At the end of each assessment, data should be registered, and different strategies are proposed to manage acute pain. The app proposes an individualised game for children in order to individualise scales and to feel identified. Children and parents fill out a satisfactory questionnaire to complete the assessment.
Investors willing to help improve global health may be interested in Dr Martinez’s work, considering the potential this application has for children worldwide.
Rocio Ortego (RO): Dr Martinez, could you please tell our readers how your research and application may change the life of millions of children?
Dr Martinez (Dr M): This tool has been validated in Acute surgical pain, in healthy children from 4 to 18 years in the recovery room of my department. We have compared it with the gold standard tool (visual paper scale). With my research, we have validated this new application with the aim to help care givers, hospital managers and children to improve pain management.
In 2005, the Ped-IMMPACT (The Paediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trial) project promoted by the IASP (International Association for the Study of Pain) made some recommendations concerning the use of different tools to be used in research in acute and chronic pain in children [vi], [vii].
On the other hand, new innovative tools are been used in medicine[viii]. In the case of pain management, these tools can not only asses pain and collect data, but also have a therapeutic effect by considering the psychosocial aspects[ix],[x], [xi]. Data can be used to improve the quality of pain management also from the parents view. According to the WHO recommendations about these tools, they should be adapted to the age group and sociocultural context, covering all pain dimensions, be easy to understand and use for all actors involved. These tools should also collect assessment data easily, and be easy to use, to be reproduced, cheap, reusable, easy to clean, involve little maintenance, be easy to charge and based on evidence. It should also be culturally adapted and proved in different languages.
RO: Where is it currently being implemented?
Dr. M. For the moment, it is being implemented at the Niño Jesus University Hospital. I have presented the project to other hospitals in Spain who showed their interest and might use it soon.
RO: What kind of support could investors, researchers, or care givers offer?
Dr. M: The idea is to continue to develop the application. We would like to translate it to other languages in order to spread it worldwide. It might be improved with new designs and even to integrate thee data collection to the hospital IT systems. I think that PainApple® has a huge potential to improve care givers pain management, and children’s pain relief if investors help in this strategy
RO: Would you like to spread your application worldwide? What about countries with limited resources?
Dr. M Yes, the idea it is to spread the application in order to change billions of lives. That it is why our aim is to translate the AAP and to make it visible for care givers. And I would like to take this opportunity also to thank Innovators mag for bringing me the opportunity to do so. There are many projects in Africa trying to strengthen healthcare systems, and PainApple® might be a tool to improve pain management if it is implemented in those countries with the help of valuable investors.
Thank you very much Dr Martinez Garcia. And congratulations in developing a new tool to improve millions of children’s lives. I really believe that global health investors will see an interesting opportunity in the field of pain management.
Dr Rocio Ortego Delgado. Global Health Expert
[i] The Nation is in the midst of an unprecedented opioid epidemic. More than 130 people a day die from opioid-related drug overdoses. https://www.hrsa.gov/opioids. Reviewed august 29th 2019
[ii] Opioid complications and side effects. Pain Physician. 2008 Mar;11(2 Suppl):S105-20.
[iii] Perioperative opioids and colorectal cancer recurrence: a systematic review of the literature. Pain Manag. 2018 Sep 1;8(5):353-361. doi: 10.2217/pmt-2018-0029. Epub 2018 Sep 13.
[iv] https://www.who.int/medicines/areas/quality_safety/guide_on_pain/en/ reviewed 18 sept 2019
[v] The Perceived Benefits of an Artificial Intelligence–Embedded Mobile App Implementing Evidence-Based Guidelines for the Self-Management of Chronic Neck and Back Pain: Observational Study. JMIR Mhealth Uhealth. 2018 Nov; 6(11): e198. Published online 2018 Nov 26. doi: 10.2196/mhealth.8127
[vi] . Carl L von Baeyer, Lara J Spagrud. Systematic review of observational (behavioral) measuresof pain for children and adolescents aged 3 to 18 years. Pain 127 (2007) 140–150.
[vii]. Jennifer N Stinson, Tricia Kavanagh, Janet Yamada, Navreet Gill, Bonnie Stevens. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents . Pain 125 (2006) 143–157.
[viii] . Ziad Obermeyer, M.D., and Thomas H. Lee, M.D. Lost in Thought — The Limits of the Human Mind and the Future of Medicine. n engl j med 377;13 nejm.org September 28, 2017.
[ix] . Miller K, Rodger S, Bucolo S, Ristan G, Kimble RM. Multi-modal distraction. Using tecnology to combat pain in Young children with burn injuries. Burns 36(2010) 647-658.
[x] . Beck E, et al. Attentional bias to pain and social threat in pediatric patients with functional abdominal pain and pain-free youth befor and after performance evaluation. PAIN 152(2011) 1061-1067.
[xi] .Davidsona F, Snow SJ, Haydenc A, Chorneya J. Psychological interventions in managing postoperative pain in children: a systematic review. Pain.2016;157:1872–1886.