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The use of an app to manage carpal tunnel syndrome

Abstract

Introduction

Mobile technology is one of the fastest growing areas of disease management. This case describes the use of a mobile phone app to overcome pain and disability associated with Carpal Tunnel Syndrome (CTS).

 

Case Study

 

Based on EMDR the app uses bilateral stimulation to change the physical and emotional dimensions of the problem. Pain, disability, and depression were measured using the Short Form McGill Pain Questionnaire, The Pain Disability Index, The Pain Self-Efficacy Questionnaire and the Beck Depression Inventory. After three months of using the app the user reported a significant reduction in pain (90%), medication usage (100%), and disability (75%), and increased confidence in her ability to control her pain (300%). These gains were maintained and even improved upon at 6 months. Surgery which had been recommended by her treating medical specialist was no longer considered necessary.

 

Conclusion

This case suggests that apps may have a role to play in the management of CTS and other chronic pain conditions

Introduction

With an estimated 40,000 health apps, including 24,000 medical apps, mobile phone applications (‘apps’) are one of the fastest growing adjuncts to the management of physical and mental illness1. A recent review found more than 6000 apps designed to address some of the most common chronic conditions2. There are apps to help track chronic pain, apps reminding people to take medications, apps to distract them from thoughts of selfharm and apps delivering cognitive behavioural therapy. Health experts are increasingly excited about the potential of apps. A recent article in the Clinical updates section of the IASP newsletter concluded that ‘mobile technologies offer significant opportunities to improve access to health care, contain costs and improve clinical outcomes3.

 

The popularity of health apps is generally thought to be based on a number of factors including convenience (most users take their smart-phone with them wherever they go), confidentiality and low cost. The average cost of an app is $1.474.

 

Apps may be used as an adjunct to treatment or as an alternative to treatment. For people who are already in treatment apps can be a useful adjunct for coping with the ‘white spaces’ in between appointments5. For the many people with mental health problems who never seek professional help, apps may offer a softer ‘firststep’ toward seeking professional help6.

 

Despite their popularity, there is very little research regarding apps. A recent review by the IASP cited four research studies regarding the use of apps to manage chronic pain. One study found that adolescents who were given an app to help manage their sickle cell disease found it helpful in terms of improved coping and functioning7. Another study found that use of an app was more efficient than using pen and paper for tracking pain8.

 

Despite these positive outcomes, concerns have been raised that this lack of research may have adverse consequences for users of health apps. Rosser & Eccleston have cautioned that the lack of research regarding apps poses a risk that “desperate individuals” may be misled9. Given the feedback pages that accompany most apps, this might not be as big a risk as has been suggested. Moreover, clinical research does not guarantee a completely unbiased view10. Nevertheless, as Vardeh et al. note, health professionals do need ‘rigorous interventional studies’ to evaluate the benefits of mobile technology11.

 

The current case report describes the use of an app to alleviate pain, disability and distress associated with Carpal Tunnel Syndrome (CTS) and arthritis pain. CTS is thought to be caused by activity which involves repetitive wrist motion, holding the wrist in awkward positions for sustained periods of time, forceful pinching or gripping and workrelated stresses12.

 

Because untreated CTS may resolve or significantly improve in up to 49% of cases13 conservative treatment is recommended initially14. Once CTS has become severe (as indicated by diminishing sensation, wasting of the thenar muscles, symptoms unchanged > 3 months) surgery is recommended. Surgery is generally effective and without it the prognosis is poorer15.

 

Anxiety Release with bilateral stimulation’ was primarily designed to help in the management of anxiety. Anxiety is the most common mental health problem in the world with a lifetime prevalence rate of 15%, and generally more common in the developed world16.

 

In addition to anxious feelings, anxiety involves significant physiological distress including muscle tension, hypervigilance, heart palpitations, headaches etc17. Anxiety is also often associated with other conditions such as depression, PTSD, and chronic pain18,19. Sufferers of acute CTS have also been found to have significantly higher rates of anxiety, both current and lifetime, than other chronic pain sufferers20.

 

The aim of this study was to evaluate the potential for an Anxiety app which incorporates sensory stimulation, to alleviate physical and emotional distress association with chronic pain.