大部分疼痛apps的开发无医生参与

佛罗里达州劳德代尔堡——美国疼痛医学会(AAPM)2013年会上报告的一项针对222款与疼痛相关的智能手机应用软件的评估结果显示，许多软件的开发并没有医疗专业人员参与，有些软件提供了错误信息，还有的并不具备其宣称的功能。

俄亥俄州立大学的Lorraine S. Wallace博士报告称，许多软件提供了应对疼痛的建议和策略，但并不知道其是否有效。此外，如果应对策略(如锻炼)并不适合用户，还有可能给他们带来危险。

专家已开始研究这些旨在向患者提供应对各种疾病方法的健康相关智能手机应用软件的安全性和有效性。
 
Wallace博士指出，理想的情况是，这些软件应由程序开发者、医生和患者合作开发。我们确实需要好的应用软件，但应该由医疗专业人员来确定开发什么样的疼痛应用软件。她建议医生应了解目前对患者有用的应用软件。

Wallace博士的研究与2011年发表的一项针对111款疼痛相关软件的英国研究相类似。后者也认为，“疼痛软件似乎能够给人们带来缓解疼痛的希望，但并没有关注其疗效或潜在不良反应。人们通常渴望获得摆脱痛苦和缓解疼痛症状的办法，但误导会给他们带来相当大的风险(J. Telemed. Telecare. 2011;17:308-12)。”


Lorraine S. Wallace博士
 
Wallace博士称，她还没有发现一款理想的疼痛相关软件。有些软件具有较好的功能，如疼痛日记或其他特色，但大多数软件的功能并不全面。

Wallace博士及其同事在苹果、安卓和黑莓应用程序商店搜索单词“疼痛”，选择了222款应用软件并评估其费用、目的和主要特点等信息，以及有关医学专业人员参与设计和(或)内容编写的证明文件。

结果显示，2009年6月~2012年7月发布的这些应用软件的平均价格≤4.99美元(仅有7款软件的价格＞9.99美元)。疼痛日记、锻炼和应对策略是这些应用软件最常见的特点。93款软件重点关注全身疼痛，57款针对背部和(或)颈部疼痛，21款针对偏头痛/头痛，1款针对肌肉疼痛，1款针对纤维肌痛、痛经、损伤、髌骨肌腱炎、风湿病以及坐骨神经痛等各种疼痛症状。

Wallace博士指出，最关键的发现是，30%的软件显然没有医疗专业人员参与设计，另外30%的软件的开发者不得而知，仅有27%的软件明确表示有医学博士或骨科博士参与开发。

研究者计划对这些软件进行更为广泛的评估，并结合其他研究结果，了解推荐这些软件的医生比例以及在什么情况下推荐这些软件。

Wallace博士报告无相关利益冲突。

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By: NASEEM S. MILLER, Internal Medicine News Digital Network

FORT LAUDERDALE, FLA. – An evaluation of 222 pain-related smartphone apps showed that many were developed without the input of a health professional, some had inaccurate information, and some of their features weren’t as robust as they could be.

"Many of them were giving advice and offering coping strategies, but we don’t know if they’re effective," said Lorraine S. Wallace, Ph.D., who led the study. In addition, the apps could potentially be dangerous for users if the coping strategy – for instance, exercise – isn’t right for them, she said.

Experts have begun studying the safety and efficacy of health-related smartphone apps, many of which are aimed at patients for managing various diseases and conditions.

Dr. Wallace said that, ideally, app developers, physicians, and patients should collaborate to create the apps. "And there needs to be a list of good apps. I always get asked ‘show us a good app,’ so there are definitely some features that we should look at, and that should be driven by health care professionals to determine what a pain app should look like," she said. She advised physicians to be aware of the apps that are currently available to patients.

Dr. Wallace said her study was modeled after a 2011 British study of 111 pain-related apps. The authors of that study also concluded, "Pain apps appear to be able to promise pain relief without any concern for the effectiveness of the product, or for possible adverse effects of product use. In a population often desperate for a solution to distressing and debilitating pain conditions, there is considerable risk of individuals being misled" (J. Telemed. Telecare. 2011;17:308-12).

Dr. Wallace of the department of family medicine and director of research at the Ohio State University in Columbus said that in her evaluation, she didn’t find an ideal pain-related app. "There were certain ones that had better features such as pain diaries or other characteristics, but most of them were not that comprehensive."

Dr. Wallace and her colleagues searched Apple, Android, and Blackberry app stores for the word "pain." They chose 222 apps, and evaluated certain information such as cost, purpose, and key features and documentation of medical professional involvement in design and/or content.

The apps were released between June 2009 and July 2012, with an average cost of $4.99 or less (only seven apps cost more than $9.99). Researchers didn’t purchase any of the apps.

Pain diaries, exercises, and coping strategies were the most common app features. Many apps focused on general pain (93), 57 addressed back and/or neck pain, and 21 dealt with migraine/headache pain. Researchers found one app for muscle pain and one for pain from each of the following conditions: fibromyalgia, menstruation, injury, patellar tendonitis, rheumatism, and sciatica.

But, "the key finding was that in 30% of the apps, there was no evidence of a health provider input," said Dr. Wallace, who presented her findings in a poster at the annual meeting of the American Academy of Pain Medicine. In another 30%, the developer was unknown, and researchers couldn’t determine whether a health provider was involved in developing the app. In only 27% of the apps was there a clear involvement of an MD or DO.

Dr. Wallace and her team are working to get the study published and are planning to do a more extensive review of the apps this year. "We’re also planning on connecting some of the studies and looking at what percentages of physicians are recommending these apps and under what circumstances."

Dr. Wallace said she had no relevant financial disclosures.