Apple Watch Can Predict Pain Levels

By Pat Anson, PNN Editor

You can monitor a lot of health conditions with an Apple Watch, everything from your heart rate and blood oxygen levels to fitness and sleep patterns. Researchers at Duke University have found the watch could also be useful in predicting pain levels in people with sickle cell disease (SCD).

In a small study recently published by JMIR Formative Research, Duke researchers used the watches to collect health data from 20 adults with SCD and used machine learning computer models to predict their pain scores.

SCD is a genetic disorder that causes red blood cells to form in a crescent or sickle shape, which creates unpredictable and painful blockages in blood vessels known as vaso-occlusive crises (VOCs). About 100,000 Americans live with SCD, primarily people of African or Hispanic descent.

Because VOC’s can lead to life-threatening infections, strokes and organ failure, knowing their intensity could lead to earlier treatment and save lives. VOCs are typically treated with pain medication and intravenous saline solutions to promote hydration.

The sickle cell patients in the study were all admitted Duke University’s SCD Day Hospital while experiencing a VOC and provided with an Apple Watch Series 3, which was worn for the duration of their visit. Data collected from the watch included their heart rate, heart rate variability and calorie consumption, which were then matched with pain scores and vital signs collected from their electronic medical records.

In all, a total of 15,683 data points were collected, which were then analyzed using three different machine learning techniques. The best performing one was the “random forest” model, which predicted pain scores with an accuracy of nearly 85 percent.

“The strong performance of the model in all metrics validates feasibility and the ability to use data collected from a noninvasive device, the Apple Watch, to predict the pain scores during VOCs,” wrote lead author Rebecca Sofia Stojancic, who works in the Sickle Cell Comprehensive Care Unit at Duke University Hospital. “It is a novel and feasible approach and presents a low-cost method that could benefit clinicians and individuals with sickle cell disease in the treatment of VOCs.”

The idea of using mobile health apps and wearable technology to predict pain scores isn’t a new one. The idea was first explored in 2019 by Duke researchers using a Microsoft Band 2 to collect data from sickle cell patients.

“The Microsoft Band 2 allowed easy collection of objective, physiologic markers during an acute pain crisis in adults with SCD. Features can be extracted from these data signals and matched with pain scores. Machine learning models can then use these features to feasibly predict patient pain scores,” researchers reported.

Could wearable devices be used someday to predict pain flares from other chronic health conditions? A handful of clinical studies have explored the use of smartphones, Fitbits and other devices to predict migraines and hospital readmissions for high-risk patients, but no results have been posted so far.

Unlikely Partners in Pain App Study

By Pat Anson, Editor

Purdue Pharma and a Pennsylvania-based healthcare provider have announced the enrollment of their first patient in a joint study of wearable health technology. As many as 240 people will eventually be enrolled in the two-year study, which is designed to see if “wearables” can help manage chronic pain.

It’s an unlikely partnership between Purdue Pharma, which faces multiple lawsuits over its promotion of the painkiller OxyContin, and the Geisinger Health System, which is actively trying to discourage the use of opioid pain medication. Geisinger provides healthcare to over 3 million people in Pennsylvania and New Jersey.

Geisinger patients enrolled in the study will get an Apple Watch and iPhone equipped with pain apps that will measure their physical activity, self-reported pain, disability, sleep quality, depression, medication use and heart rate.

Patients who report pain will be prompted to try non-pharmaceutical alternative therapies, such as stretching, mindfulness and thermotherapy.

“The goal of this technology is to improve patient function and quality of life while reducing the need for analgesic medications. It provides objective measures of numerous aspects of pain, function and treatment effectiveness so that information can be gathered for the patient and the healthcare provider in between visits,” said Dr. Tracy Mayne, who heads Medical Affairs Strategic Research at Purdue Pharma.

“We are pleased to partner with Geisinger on this important initiative and believe real-time data may have the potential to support an improved understanding of chronic pain patients’ experiences and needs.”

The study's primary goals are to assess whether the use of wearables can reduce pain, depression, medication use, and healthcare costs.

“We are incorporating advanced technology into the traditional healthcare setting to redirect and empower the patient to take more control of their own well-being. The proposed multi-level integrated platform will facilitate and accelerate the speed of communication between the patient and healthcare providers, thereby allowing quicker patient access to appropriate care,” said John Han, MD, director of Pain Medicine at Geisinger.

“Furthermore, it is hoped providing more education as well as alternative, non-opioid treatment options and coaching to promote a long-term sustainable healthy lifestyle will improve patient function and quality of life.”

Further details about the study can be found here.

The study comes as Purdue fights a seemingly endless series of court battles with state and local governments over its marketing of OxyContin over a decade ago. Critics contend the overprescribing and abuse of OxyContin helped launch the overdose crisis.

A recent study by Geisinger found that opioids are ineffective in treating chronic pain and increase the risk of overdose and death.

"Opioids are not the answer," said Mellar Davis, MD, a palliative care physician for Geisinger. "Chronic pain rehabilitation, exercise, cognitive behavioral therapies, acupuncture, yoga or tai chi are all better options than opioids."