A checkup on Pain Squad, the Canadian app that gamified health care

A Canadian app that literally lets young cancer patients put pain management in their own hands is poised to make the leap from clinical trials to Apple’s App Store next year.

And the Pain Squad iPhone app has been so successful in trials that an enhanced version is also now in the works called Pain Squad Plus.

The original app was developed by Toronto communications agency Cundari Group Ltd. and medical researchers at Toronto’s SickKids Hospital. Kids and teens with cancer use the app to track the intensity, location and duration of their pain. They also use it to record the impact of various treatments on their pain.

“I want to have data that helps me understand what’s causing pain in children with cancer,” said Dr. Jennifer Stinson, scientist and nurse practitioner with the Chronic Pain Program at SickKids. “For patients we don’t always have tools to help them be more aware of pain they’re having. And in some cases (with the app) they realize they should be talking to their healthcare provider about it,” said Stinson, lead researcher on the Pain Squad project.

Based on the app data, doctors can adjust the young patients’ treatment accordingly. SickKids researchers also use the data to help determine the overall effectiveness of various pain management treatments. Getting the kids to record their pain with the app is crucial for the program to work well. That’s where gamification kicked in.

Cundari designed the app like a game featuring a fictional police investigation. Video messages from stars of the TV series Rookie Blue and Flashpoint pop up to motivate patients to fill out their electronic pain journals. The kids start out as ‘rookies’ but get promoted to higher ranks such as ‘sergeant’ or ‘captain’ if they continue to fill in their pain data.

Gamification improved the pain reporting rate to a range of 80 to 90 per cent in one study, significantly higher than the rates for paper or non-gamified electronic pain journals, said Dr. Stinson.

It also helped restore a sense of control to the young patients’ lives.

“In talking to the parents, it almost became a weapon against the pain. (The kids) don’t have a lot of control. They get told where to be, when and what to eat, aren’t allowed to see their friends as much and get taken out of school. This was their bit of governance or control where they didn’t have a lot of control,” said Cory Eisentraut, group creative director at Cundari.

The Pain Squad app has won several awards, including two gold lions at Cannes, a gold CLIO and a FastCo Innovation by Design Award. SickKids completed a third phase of pilot testing on the app in May 2012. Besides SickKids, pediatric cancer centres in Vancouver, Ottawa and Hamilton, Ont. have also used the app. A combined total of about 80 young patients across Canada have used it so far.

That number will grow if the Pain Squad app debuts in the Apple App Store as planned in 2014. An enhanced version called Pain Squad Plus is now being developed with a release date targeted for some time in 2015, said Dr. Stinson. That version would send patients pain management tips and automatically alert their healthcare providers if their pain reaches a certain severity.

The success of the Pain Squad app doesn’t necessarily mean a flood of similar healthcare apps will hit the market soon, however. According to an IDC Canada study released in May, Canada’s healthcare sector lags behind business and other private sectors in this country when it comes to adopting apps and other mobile technology. In the survey, 46 per cent of Canadian healthcare providers said they still hadn’t deployed any mobile applications. The corresponding figure for all other industries was just 37.5 per cent.

“Generally, the healthcare sector is still sitting on a lot of legacy processes with pen and paper filing systems. Making that jump can be a big one,” said study co-author Alison Brooks, public sector research director at IDC Canada.

Although some critics are quick to blame tight government funding, Brooks said privacy and security concerns are two major factors delaying mobile adoption in Canadian healthcare today. The healthcare sector is working with federal and provincial privacy commissioners to overcome those concerns, she added. But mobile developers still have to bring their ‘A’ game when it comes to designing healthcare apps that aren’t just effective but enjoyable to use, said study co-author Krista Napier.

“You need the buy-in of the end patient and caregivers to actually use (an app). You can roll something out but if nobody wants to use it, it won’t be successful,” said Napier, senior mobility analyst at IDC Canada.