A Multidimensional Digital Approach to Pain Assessment in Sickle Cell Disease: A Feasibility Study in Ghana

Abstract

Purpose: Pain is the most common symptom in sickle cell disease (SCD). Due to a lack of objective markers, pain assessment relies on patient report, which can be highly subjective and lead to miscommunications regarding care. While digital pain tools show promise for improving pain communication, digital literacy barriers and cultural differences may limit their use, particularly in low- resource settings. There is a lack of data on the effectiveness of digital pain tools in sub-Saharan Africa, the region with the highest burden of SCD. Painimation is a digital application that uses animations and graphical images to assess pain location, quality, and intensity. We evaluated its feasibility, acceptability, and utility in a Ghanaian SCD cohort. Patients and Methods: This cross-sectional study was conducted at Korle-Bu Teaching Hospital in Ghana. Individuals age >10 years with SCD were recruited from the pediatric and adult SCD clinics. Participants were asked to use Painimation and complete a clinical history and an 11-item questionnaire addressing the feasibility, utility, and acceptability of the app. Results: Of the 38 consented patients (66% female, median age: 16 years), 87% reported being comfortable using the touchscreen, and 74% said the app was easy to use. Most participants (68%) reported the app was not burdensome to complete during a pain episode. Participants reported that the body shading (92%), animation selection (92%), and intensity adjustment (87%) features were useful for communicating pain. The app took 102 seconds to complete on average. The most commonly selected pain animation was throbbing (50%), and the most frequently reported pain locations were the legs (35%), back (42%), arms (35%), and chest (35%). Conclusion: Painimation was feasible, acceptable, and useful for pain reporting in this Ghanaian SCD cohort. Pain reports using Painimation mirrored known SCD pain profiles, with predominant throbbing pain and frequent leg and back involvement. Digital health tools may improve pain assessment and management in low-resource settings in sub-Saharan Africa.