Pain patient states: transforming chronic pain care

If you have ever sought care for any kind of pain, you have likely been asked: “What is your pain level?” You may have provided your best guess from zero to 10 or pointed your finger to a scale with a sad face on one end and a happy face on the other.

These common and simple forms of measurement fall short for chronic pain – a complex condition that impacts many aspects of a person’s life.                                                                                                   

What does that number or sad face really define?

To me, it does not express as much as is really needed. It might record the perception of pain that the person is experiencing at that moment, but it does not paint the whole picture. For example, it does not represent how the pain experience fluctuates during different activities, how those activities are affected by pain or the effect pain has on sleep or mood.

Think of it this way: If you twist your ankle and do not move it or put weight on it, you might register your pain level as very low, maybe even 0 or 1. But your overall quality of life is adversely affected in a more significant way once you get up and walk around, especially if the pain becomes a chronic condition.  

For the 30% of people worldwide living with chronic pain[1], which is defined as continuous pain lasting for more than three months[2], the pain experience is more than just a number. In fact, when we have asked people with chronic pain about how it impacts their lives, pain intensity is not always first on the list. Yes, it is a symptom of their condition. But they also share how they cannot play with their kids, sleep or enjoy other activities.

If we cannot measure, describe and understand people’s pain experience in a simple way, delivering to them the best, most personalized care becomes very difficult.

A new way to measure the chronic pain experience

Six years ago, Boston Scientific took this challenge on through a collaboration with IBM Research that aimed to combine our collective experience in neuro-engineering, clinical research and regulatory expertise with data science and artificial intelligence (AI) know-how. Together, our teams of engineers and scientists asked one important question: Can we better define the individual experience of chronic pain?

The collaboration, along with a new digital ecosystem for people with pain, provided unique clinical data through NAVITAS and ENVISION. These two innovative, multi-site clinical studies of people eligible for spinal cord stimulation therapy for chronic pain started an eye-opening discovery journey.

First, we received a holistic profile of people’s individual experiences with pain through in-clinic and at-home data. This data was collected through daily questionnaires, smartwatches, and physician feedback about a patient’s mood, alertness, sleep, medications, pain intensity and mobility.

Then, by applying AI and other analytic techniques to this data, we identified several universal factors that work together to produce an index that describes the overall pain experience beyond just pain. These insights allowed us to create a single, simple metric to better understand how a person’s chronic pain experience changes over time.

We named that new metric the Pain Patient States.

We have found that all patients fluctuate between five specific Pain Patient States that reflect the overall pain experience (mood, alertness, sleep, medications, pain intensity, mobility). By understanding how each person’s experience of pain tends to change between these states, we can have a simple and actionable way to recognize when patients require intervention to improve their well-being.

At Boston Scientific, we have already created spinal cord stimulation devices that can be used to deliver personalized therapies. To take this a step further, we are also researching how these therapies can be adjusted for each person on a more continuous basis through our work with IBM in AI.

Ultimately, this gets us closer to our vision of a smart closed-loop system in which our Pain Patient State metric provides a holistic view of each pain patient’s day-to-day journey, and the system provides therapy recommendations to help each patient reach and maintain their best state. In addition, as our technology platforms and devices evolve, we envision that physicians will have access to on-demand reports describing how each of their patients are experiencing pain and reacting to their current treatment, as well as actionable insights and tailored therapy recommendations in a timely way.

This approach is designed to help address the limitations of measuring chronic pain with a snapshot, only one dimension at one moment in time. Our holistic and comprehensive approach has the potential to make a profound impact on the way people with chronic pain are managed and treated.

While our work with IBM Research is ongoing, we must consider what this new way to objectively measure chronic pain could mean for the future of health care. The ability to quantify the pain experience in real time, for instance, may lead to new paths to better treat other chronic conditions impacting humankind.

I feel privileged to be able to play a small part in the important work that our teams are doing to help shift the treatment paradigm so people living with chronic pain – and possibly one day, other conditions – can live better, healthier lives.