Back pain: can apps offer relief?

Back pain is extremely common; about 80-90% of us will experience it at some point.

Less daily movement, poor home-working setup, or overwork during the pandemic have also exacerbated the issue for many in recent times.

So an app that promises to relieve or even cure back pain certainly sounds promising, especially if it means you can work through exercises yourself at home, without the cost or time impact of having to travel anywhere.

But while these apps may have their place, it's worth being wary of anything that professes to be a miracle cure.

We've looked into what exercise and pain management apps such as Kaia and Curable offer, the evidence behind them, and got insights from experts on whether they're worth a try.

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Exercise apps for back pain

When we asked leading health experts what the best medicine for a bad back is, all stressed the importance of getting moving again.

There's evidence that activities such as pilates, yoga and tailored physio exercises help, but almost any form of movement or exercise is positive.

The principle for apps to help with back pain is broadly the same as a home workout video: they offer guided exercises to help you get moving and reach a goal, such as increased mobility or pain reduction.

Though there are back-pain-specific exercise apps, you can use any exercise app that you enjoy and that works for you - there isn't strong evidence that one particular type works over another.

The effectiveness of apps like this haven't been rigorously assessed, but there is good evidence that exercise and movement can have an effect on back pain.

It's worth noting that while health apps have to go through some regulatory checks to get themselves listed on the App Store or Google Play store, it's unclear how rigorous these checks are or what they contain.

The Google Play store, unlike the App Store, doesn't make any distinction between apps offering health or medical advice and regular apps in its checks.

The bottom line? These apps aren't offering anything ground-breaking, but they might help if you find that following a programme on your phone encourages you to get moving.

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Chronic pain apps

For most cases of back pain, symptoms should improve substantially over the first few weeks, regardless of medical intervention, says Dr Neil O'Connell from the Cochrane Pain, Palliative and Supportive Care group.

But for 8-10%, this pain can become chronic and debilitating - lasting for more than 12 weeks.

There's no simple answer for chronic back pain sufferers, says Dr Andrew Moore, former director of pain research at Oxford University. Treatment is complex and needs good professional advice tailored to individuals.

A new breed of apps for chronic pain - like Curable and Kaia - are looking to fill this brief.

Is Curable's 'brain training' approach the answer?

Curable focuses on the brain's role in chronic pain, using an approach called 'pain reprocessing therapy' (PRT), which works on the assumption that recurring pain can be caused or exacerbated by the brain misinterpreting sensations, sending off pain signals incorrectly.

PRT attempts to retrain the brain and break the cycle of pain.

The Curable app (£58.99 for a yearly subscription), uses a combination of cognitive behavioural therapy techniques, guided meditations, pain reduction visualizations, and expressive writing techniques, among other methods, to combat pain - accessed via a 'virtual assistant'.

As of yet, there haven't been any clinical studies into apps like Curable. One 2019 study found that Curable was one of the better apps for self-management of pain, but noted that none of the apps in the study had been properly evaluated in people with persistent pain (Curable has done its own research on outcomes from use of the app).

Dr Moore cautions that 'there is increasing concern that psychological therapies delivered remotely have little or no effect in people with chronic pain, and about the quality of studies themselves, in terms of what exactly is being delivered, and by whom - according to a 2021 protocol for a Cochrane review.'

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Pain management and apps

Kaia is another pain management app that specifically tackles musculoskeletal pain, through a combination of physical movement, relaxation exercises, and education.

It's currently only available as part of certain employee benefit or health insurance plans.

A 2020 randomised control trial found that the Kaia app - when used as part of a GP-led digital intervention programme - showed good pain, anxiety and depression reduction in people with chronic lower back pain, compared to regular guideline-based intervention involving face-to-face physiotherapy and online educational resources.

So, it's possible that with proper clinical oversight, digital interventions into chronic back pain could offer some much needed relief - but we're in the early stages still and more evidence is needed.

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