Plain speaking on pain

Professor Pat Schofield

As our ageing population puts more pressure on health services, Professor Pat Schofield is exploring how computer technology could help older patients to self-manage chronic pain.

Britain is often described as facing a demographic ‘timebomb’. Specifically, the proportion of older people is growing, and by 2046, it is estimated that over-65s will make up nearly a quarter of the population. While this is to be celebrated, it also means that we will have more older people, fewer people to care for them, and even greater strain on health and social care services.

Under these circumstances, it is likely that we will need to find new ways to look after each other, and ourselves, to supplement the work of healthcare professionals. Professor Pat Schofield has been examining how this might be achieved with one of the biggest health concerns affecting older people: chronic pain.

"Up to 62% of people aged over 75 in Britain report chronic pain symptoms, but their daily struggles are often neglected. Older people are often expected to live with it."

Pain is deemed ‘chronic’ when it lasts for months or years. In total, there are more than 200 such conditions, of which the most common is low back pain, followed by forms such as migraine, arthritis, and musculoskeletal pain.

Up to 62% of people aged over 75 in Britain report chronic pain symptoms, but their daily struggles are often neglected. “Older people are often expected to live with it,” Pat explains. “The attitude is almost; ‘You’re getting older, what do you expect?’”

Although chronic pain can be handled in various ways, in a world where GP appointments are limited to seven minutes each, Pat is especially interested in self-management. This involves helping patients to adopt what are often commonsense techniques to minimise the pain’s impact, for example, by teaching them to pace their lifestyles to prevent it from flaring up.

Enabling patients to make these judgements, however, relies on them having access to the right information. Pat’s latest study has examined how this could be done using computer software called ‘Chatbot Author’ – a web programme developed by the Essex-based company Df2020.

Chatbot Author allows users to create a scripted chatbot, through which a desktop computer, tablet, or smartphone can have a conversation with a human. It can be customised to talk about any subject, and is a potentially useful way to give people clear information on complex issues.

"Self-management involves helping patients to adopt what are often commonsense techniques to minimise the pain’s impact."

Using funding from the National Institute of Health Research and Innovate UK, Pat set up a study in which Chatbot was programmed to help people with low back pain. The system starts by asking the user how they are. If the answer is ‘not good’, it then asks more questions, gradually directing them to appropriate action.

The scripts were checked thoroughly with specialists from institutions such as the British Geriatric Society, in particular to ensure that the system would be able to spot potential emergencies. The real test came, however, when Pat’s team tried it out on focus groups of over-65s.

Despite older people’s widespread reputation as technophobes, many of them loved the approach. “At first they weren’t sure,” Pat admits. “Then we broke for tea and cake, and they all started looking at Facebook on their phones! I think it’s very much a case of how you sell this technology – if it addresses an issue that matters to them, they’re usually up for it.”

Pat is now seeking funding to do further tests. If these are successful, she believes that within a year, a system could exist through which GPs prescribe low back pain patients a package involving a simple tablet computer set up to run Chatbot. This could eventually be rolled out for other types of chronic pain, and perhaps different conditions as well.

The older people whom Pat consulted were rightly concerned that such a system might replace their trusted local GPs. Pat stresses, however, that the aim is rather to ensure that they make better use of human healthcare professionals when they need to do so.

“I wouldn’t for one minute expect the technology to replace doctors,” she says. “But we know that by 2050 we will have many people aged over 65 and not enough people to look after them. We need to find ways to handle that through self-management now.”