UK Researchers Help Victims of Violence Manage Chronic Pain With Mobile App for Breathing Techniques

photo of woman using smartphone
photo of smartphone app

LEXINGTON, Ky. (May 23, 2017) — Researchers from the University of Kentucky are studying how to help victims of sexual and domestic abuse alleviate chronic pain using a smartphone application.

Charles Carlson, professor of psychology in the UK College of Arts and Sciences, and Matt Russell, a doctoral candidate in clinical psychology, are currently conducting the first clinical trial of its kind at the UK Orofacial Pain Clinic on patients experiencing myalgia and other chronic pain in the head and neck regions. Carlson, who is also the Robert H. and Anna B. Culton Endowed Professor in the UK Center for Research on Violence Against Women (CRVAW), says a significant portion of the clinic’s female patients have suffered from sexual or physical abuse at some point in their lives, which often results in a prolonged state of activity that can contribute to pain within the body. 

Literature suggests trauma often causes a prolonged state of increased sympathetic tone within the body,” Carlson said. “The chronic hypervigilance may be associated with scanning for danger around every corner. The resulting hypervigilance that often comes from a person’s experience with trauma, over time, leads to a state of prolonged and unnecessary muscle tension and eventually, if unchecked, may contribute to muscle-based pain conditions such as myalgia. It is not surprising, therefore, that a significant number of our patients with chronic pain reported experience with physical or sexual abuse."

As a clinical psychologist, Carlson, and senior clinical psychology graduate student, Russell, both want to help patients learn to calm their hypervigilance through strategies which can help manage the excessive activation of muscle-based pain. Their previous research shows that chronic pain patients can help manage and control muscle-based pain through self-regulation strategies that include slow-paced, diaphragmatic breathing — a form of relaxation training.

“Breathing with the use of the diaphragm muscle is one of the body's most efficient ways to induce a parasympathetic (rest and digest) response that will help calm the sympathetic (fight and flight) activity often associated with pain or other external/internal stressors,” Carlson said. “As a result, the scientific literature suggests slow-paced diaphragmatic breathing can be helpful for management of chronic pain conditions such as myalgia, migraines and fibromyalgia, or other health concerns such as irritable bowel syndrome, hypertension or insomnia."

Diaphragmatic breathing is a practice most people can learn, so Carlson and Russell are exploring whether patients can help manage their pain by learning to breathe diaphragmatically without the use of a professional therapist. By providing patients with a mobile application that teaches the diaphragmatic breathing approach, the team hypothesizes patients will learn to self-regulate their body’s sympathetic tone to manage their pain. 

“We designed the smartphone application to teach patients the basics of paced, diaphragmatic breathing with audio directions only,” Russell said. “Then, we use a visual aid to help pace their breathing, an important piece of strengthening the parasympathetic response.”

The current project will examine the effectiveness of the smartphone health intervention to improve treatment outcomes above standard dental care. The participants recruited through the Orofacial Pain Clinic will receive either standard dental care alone, or standard dental care plus the mobile application on their iPhone/iPad, or a provided iPod Touch. Patients using the application will track their daily breathing practices and pain levels, while those receiving standard dental care alone will track only their pain levels. All participants will complete weekly assessments, and at each clinic follow-up visit, participants’ progress will be monitored by collecting measures of their current self-regulation skills.

“Through the application, we hope to reach a larger number of the patients we see at the Orofacial Pain Clinic who do not have the means to return for clinician-directed training,” Russell said. "Ultimately, we hope to make this research-based application available to dental providers as a means to assist in the care of pain patients.”

While a quick iTunes search can result in hundreds of apps that promote “breathing strategies” to treat various ailments, Carlson emphasizes the importance of empirical evidence.

“To our knowledge, there are no published studies empirically validating that these applications can deliver on their promises,” he said. “As clinical scientists, we believe that before we tell our patients our application will help, we need evidence from a scientific study."

“In the Center for Research on Violence Against Women, we are so appreciative of Dr. Carlson’s research focus, which gives such breadth to the center’s projects which are often focused on the psychosocial impacts or public health aspects of violence against women,” said Diane Follingstad, director of the center. "And it will be exciting to see whether addressing physical ramifications of abuse through technology will provide a more accessible method for women who may not be able to afford medical treatment."