A randomized controlled trial of mobile-based contingency management to promote self-monitoring among individuals with chronic pain.

OBJECTIVE

Strategies are needed to sustain daily monitoring of pain symptoms and related behaviors. However, low adherence rates have impeded the use of self-monitoring among chronic pain patients. This pilot study tested a novel mobile-based contingency management (CM) intervention promoting self-monitoring of pain symptom severity, related variables, and prescription opioid use among individuals with chronic pain.

DESIGN

A parallel-arm randomized controlled trial (RCT).

SETTING

Online recruitment via ResearchMatch.org.

PARTICIPANTS

Adults (N = 81) with noncancer chronic pain (≥3 months) and lifetime opioid prescription(s) for pain management were randomized to either the CM group (n = 46) or the control group (n = 35). Of those randomized, n = 72 completed follow-up.

INTERVENTIONS: A fully automated CM app (DynamiCare Rewards) delivered incentives on an escalating variable-ratio reinforcement schedule over 28 days.

MAIN OUTCOME MEASURES: The number of completed daily surveys and the longest period of continuous daily survey completion were compared using independent t-tests. Feasibility and acceptability measures were also examined.

RESULTS

CM participants completed significantly more daily surveys (26.09 vs 23.06; p = .03) and had significantly longer sustained periods of daily survey completion (22.07 vs 17.11; p = .01) than the control participants. Acceptability ratings were high and similar for the two groups (all p > .05).

CONCLUSIONS

This study is the first to test an app-based escalating variable-ratio CM schedule for promoting sustained daily pain self-monitoring. Findings indicate a large-scale RCT may be warranted. Establishing a valid method for improving self-monitoring adherence has broad research implications. Future studies will explore other target behaviors and examine relationships between pain symptom severity and related variables, eg, sleep.