This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.
Chronic pain is a major health issue requiring an approach that not only considers medication, but also many other factors included in the biopsychosocial model of pain. New technologies, such as mobile apps, are tools to address these factors, although in many cases they lack proven quality or are not based on scientific evidence, so it is necessary to review and measure their quality.
The aim is to evaluate and measure the quality of mobile apps for the management of pain using the Mobile App Rating Scale (MARS).
This study included 18 pain-related mobile apps from the App Store and Play Store. The MARS was administered to measure their quality. We list the scores (of each section and the final score) of every app and we report the mean score (and standard deviation) for an overall vision of the quality of the pain-related apps. We compare the section scores between the groups defined according to the tertiles via analysis of variance (ANOVA) or Kruskal-Wallis test, depending on the normality of the distribution (Shapiro-Wilk test).
The global quality ranged from 1.74 (worst app) to 4.35 (best app). Overall, the 18 apps obtained a mean score of 3.17 (SD 0.75). The best-rated sections were functionality (mean 3.92, SD 0.72), esthetics (mean 3.29, SD 1.05), and engagement (mean 2.87, SD 1.14), whereas the worst rated were app specific (mean 2.48, SD 1.00), information (mean 2.52, SD 0.82), and app subjective quality (mean 2.68, SD 1.22). The main differences between tertiles were found on app subjective quality, engagement, esthetics, and app specific.
Current pain-related apps are of a certain quality mainly regarding their technical aspects, although they fail to offer information and have an impact on the user. Most apps are not based on scientific evidence, have not been rigorously tested, and the confidentiality of the information collected is not guaranteed. Future apps would need to improve these aspects and exploit the capabilities of current devices.
Pain is defined by the International Association for the Study of Pain (IASP) as a “distressing experience associated with actual or potential tissue damage, with sensory, emotional, cognitive, and social components” [
“Chronic” and “pain” have been constantly popular keywords on search engines over the last 5 years, which could be related to the increasing prevalence of this condition in recent years [
Treating chronic pain is a tricky task because it should involve much more than simply drugs. The biopsychosocial model states that pain is “a dynamic interaction among and within the biological, psychological, and social factors unique to each individual” [
The number of mobile health apps has grown recently, having been classified as an “exploding market,” with more than 100,000 specific apps [
Mobile apps specifically for pain have also increased, with there now being over 350 apps according to the review by Portelli and Eldred [
The traditional systems to try to measure the quality of the apps include the opinions and/or satisfaction of the users, the stars rating system, the app description, or checklists. None of these strategies seems to be adequate to scientifically measure the quality of the apps. For instance, the descriptions of the apps in the stores may be incomplete or imprecise, the scores and opinions may include the subjectivity of nonexpert users or be based on the opinion of very few people making it difficult to generalize, and checklists do not actually assess quality [
Interest over time in the term “chronic pain.” Results obtained through Google Trends. The values, expressed in percentages, reflect the number of searches done for the term relative to the total number of searches done on Google over time.
There is an alternative tool for assessing the quality of health mobile apps, namely the Mobile App Rating Scale (MARS) [
Finally, given the changing nature of the apps market, there is always a need for an updated review which includes the new apps that may have been released recently. In view of the preceding, this study aims to evaluate and measure the quality of mobile apps for the management of pain using the MARS.
This study included pain-related mobile apps (both free and paid) found in the official stores of Apple iPhone (App Store) and Android (Play Store) in June 2017. These two systems are the most widely used according to the latest report by Kitagawa et al [
Firstly, we defined the disease of interest using the following generic terms: “pain” and “
A total of 18 apps were finally included (2 from the App Store, 11 from the Play Store, and 5 multiplatform). These apps were randomly divided into three groups, each of which was assigned to two reviewers, who downloaded the assigned apps on their devices, used, and evaluated them by means of the MARS [
The MARS [
The discrepancies in the scores between reviewers were assessed and if major differences were found in a specific app (more than 2 points of difference), the items of the MARS were compared. In case of disagreement, the third reviewer intervened to evaluate and reach a consensus, except for one app (Change Pain), which was no longer available when the third reviewer tried to evaluate it and was eventually removed from the study. The final score for each app was calculated as the mean of the scores of each reviewer, after verifying that the scores were similar and that there was consensus. The apps were then classified as worst-rated apps, average apps, and best-rated apps according to the tertiles of the final scores. This classification based on tertiles gave us a cut-off point for an app to be considered a best-rated app.
A descriptive analysis was performed. We list the scores (of each section and the final score) of every app and we report the mean score (and standard deviation) for an overall vision of the quality of the pain-related apps. Additionally, we compare the section scores between the groups defined according to the tertiles via analysis of variance (ANOVA) or Kruskal-Wallis tests, depending on the normality of the distribution (Shapiro-Wilk test). The analyses were performed with SPSS version 21, and the figures with Excel 2016.
Structure of the MARS.
Section | Definition |
A: Engagement | Fun, interesting, customizable, interactive (eg, sends alerts, messages, reminders, feedback, enables sharing), well-targeted to audience |
B: Functionality | App functioning, easy to learn, navigation, flow logic, and gestural design of app |
C: Esthetics | Graphic design, overall visual appeal, color scheme, and stylistic consistency |
D: Information | Contains high-quality information (eg, text, feedback, measures, and references) from a credible source. Select N/A if the app component is irrelevant |
App quality | Mean score of sections A, B, C, and D |
E: App subjective quality | Personal interest in the app |
F: App specific | Perceived impact of the app on the knowledge, attitudes, and intentions to change of the users, as well as the likelihood of actual change in the target health behavior |
A total of 47 nonduplicate apps were initially identified as potential pain apps to be included in this study. Of these, 28 did not meet the inclusion criteria and were excluded, making a total of 19 apps analyzed, although one of the apps was eventually removed due it being unavailable in the stores when trying to solve the lack of consensus. Therefore, a final total of 18 apps were included (
The specific scores for each app are shown in
Flowchart of the pain-related app selection.
Description of the pain-related apps included in the study.
App name | Platform | Price (€) | Downloads | Developer | Affiliations |
Manage My Pain (Lite & Pro) | Android | Free (Lite); €3.99 (Pro) | 50,000-100,000 | ManagingLife | Commercial |
Diario de Dolor CatchMyPain (Lite & Pro) | Android-iOS | Free (Lite); €3.59 (Pro) | 50,000-100,000 | Sanovation AG | University |
Mi registro de dolor | Android-iOS | Free | 1000-5000 | Subinprara Infotech Inc | Commercial |
Pain Companion | Android | €1.09-€33.20 per element | 5000-10,000 | Sanovation AG | Commercial |
OurHurt-Dolor Crónico | Android | Free | 1000-5000 | Labs Health Company | Commercial |
My Pain Diary | Android | €3.66 | 1000-5000 | DemoLab, LLC | Commercial |
ACPA Pain Logs | Android-iOS | Free | 500-1,000 | ACPA | Commercial |
Chronic Pain Diary | Android | Free | 5000-10,000 | Jet5 | Commercial |
Pain Tracker HD | Android-iOS | €0.89 per element | 100-500 | AppYourWay | Commercial |
Painometer v2 | Android | Free | 1000-5000 | Algos-Research on Pain | University |
My Pain Diary & Symptom Tracker: Gold Edition | iOS | €5.49 | 1000-5000 | Damon Lynn | Commercial |
PainTrakr | iOS | Free | 1000-5000 | Black Slate Software Inc | Commercial |
Pain Tracker & Diary by Nanulume | Android-iOS | €2.99 | 1000-5000 | Nanolume, LLC | Commercial |
GP Pain Help | Android | Free | 1000-5000 | Australian College of Rural & Remote Medicine | University |
Pain Log | Android | Free | 1000-5000 | Raúl R | Commercial |
Pain Score | Android | Free | 500-1000 | Trinstor | Commercial |
Pain Rating Scales | Android | Free | 1000-5000 | ETZ | Commercial |
Pain Treatment | Android | Free | 10,000-50,000 | Entertain2Dunia | Commercial |
Characteristics of the included pain-related apps.
App name | Focus (what the app targets) | Theoretical background/strategies | Technical aspects of app |
Manage My Pain (Lite & Pro) | Physical health | Monitoring/tracking | Allows sharing (eg, Facebook, Twitter); allows password protection; requires log-in; sends reminders; needs Web access to function |
Diario de Dolor. CatchMyPain (Lite & Pro) | Increase happiness/well-being emotions; reduce negative; anxiety/stress; physical health | Assessment; feedback; monitoring/tracking | Allows sharing (eg, Facebook, Twitter); allows password protection; requires log-in; sends reminders; needs Web access to function |
Mi registro de dolor | Physical health | Assessment; feedback; monitoring/tracking | Allows password protection; requires log-in; sends reminders |
Pain Companion | Increase happiness/well-being; goal setting; entertainment; relationships; physical health | Assessment; feedback; information/education; monitoring/tracking; advice tips/strategies/skills training; gratitude | Allows sharing (eg, Facebook, Twitter); has an app community; allows password protection; requires log-in; sends reminders; needs Web access to function |
OurHurt-Dolor Crónico | Physical health | Monitoring/tracking; strengths | Allows sharing (eg, Facebook, Twitter); allows password protection; requires log-in |
My Pain Diary | Depression; anxiety/stress; physical health | Monitoring/tracking | Allows sharing (eg, Facebook, Twitter) |
ACPA Pain Logs | Physical health | Assessment; feedback; monitoring/tracking | Allows sharing (eg, Facebook, Twitter); allows password protection; requires log-in |
Chronic Pain Diary | Physical health | Monitoring/tracking | —a |
Pain Tracker HD | Physical health | Monitoring/tracking | Allows password protection; requires log-in; sends reminders |
Painometer v2 | Physical health | Assessment; monitoring/tracking | Allows sharing (eg, Facebook, Twitter) |
My Pain Diary & Symptom Tracker: Gold Edition | Depression; anxiety/stress; physical health | Feedback; monitoring/tracking | Allows sharing (eg, Facebook, Twitter); has an app community |
PainTrakr | Physical health | Monitoring/tracking | Sends reminders |
Pain Tracker & Diary by Nanulume | Physical health | Monitoring/tracking | Requires log-in; sends reminders |
GP Pain Help | Physical health | Assessment; information/education | — |
Pain Log | Physical health | Monitoring/tracking | — |
Pain Score | Physical health | Assessment; information/education | — |
Pain Rating Scales | Physical health | Assessment; information/education; monitoring/tracking | — |
Pain Treatment | Physical health | Assessment; information/education; advice/tips/strategies /skills training | Allows sharing (eg, Facebook, Twitter) |
aThe app does not have any of the technical aspects considered in the MARS.
Mobile App Rating Scale (MARS) scoring of the pain-related apps.
App name | App quality, mean (SD) | Ta | Sectionb, mean (SD) | User’s stars score | |||||
A | B | C | D | E | F | ||||
Pain Companion | 4.35 (0.49) | T1 | 4.60 (0.55) | 4.25 (0.05) | 4.83 (0.06) | 3.72 (1.62) | 4.25 (0.50) | 4.42 (0.52) | 4.30 |
Manage My Pain (Lite & Pro) | 4.22 (0.18) | T1 | 4.40 (0.89) | 4.13 (0.03) | 4.33 (0.03) | 4.00 (0.38) | 3.75 (1.00) | 3.67 (0.82) | 4.00 |
My Pain Diary & Symptom Tracker: Gold Edition | 4.02 (1.08) | T1 | 4.30 (0.84) | 4.50 (0.50) | 4.83 (0.58) | 2.43 (2.15) | 4.38 (0.82) | 3.42 (0.82) | N/Ac |
OurHurt-Dolor Crónico | 3.88 (0.65) | T1 | 3.40 (1.14) | 4.75 (0.05) | 4.00 (0.58) | 3.36 (1.50) | 3.88 (0.50) | 3.17 (0.52) | 3.90 |
Pain Tracker & Diary by Nanulume | 3.79 (0.43) | T1 | 3.50 (1.52) | 4.38 (0.50) | 3.83 (0.58) | 3.43 (1.70) | 3.88 (0.82) | 3.33 (0.63) | 2.50 |
My Pain Diary | 3.73 (1.17) | T1 | 4.10 (0.71) | 4.50 (0.50) | 4.33 (1.00) | 2.00 (1.51) | 4.00 (0.82) | 3.08 (0.55) | 4.20 |
Mi registro de dolor | 3.60 (1.20) | T2 | 4.30 (0.84) | 3.75 (0.50) | 4.50 (0.58) | 1.86 (1.57) | 3.50 (1.50) | 3.34 (1.26) | 3.70 |
Diario de Dolor. CatchMyPain (Lite & Pro) | 3.35 (0.48) | T2 | 3.60 (0.45) | 3.50 (0.58) | 3.67 (0.07) | 2.64 (1.98) | 2.88 (0.50) | 2.75 (0.98) | 4.00 |
ACPA Pain Logs | 3.16 (0.41) | T2 | 2.40 (0.55) | 3.00 (0.50) | 3.33 (0.06) | 2.64 (1.07) | 3.75 (0.50) | 2.25 (0.41) | 3.00 |
GP Pain Help | 3.10 (0.90) | T2 | 2.30 (1.34) | 4.38 (0.50) | 3.00 (0.58) | 2.71 (2.37) | 2.13 (0.96) | 2.83 (1.22) | 4.80 |
Pain Log | 3.08 (1.03) | T2 | 1.70 (1.30) | 4.13 (0.04) | 3.50 (1.00) | 3.00 (1.50) | 2.00 (1.26) | 1.83 (0.52) | 4.40 |
Pain Rating Scales | 2.83 (0.89) | T2 | 2.10 (0.02) | 4.13 (0.82) | 2.66 (0.03) | 2.43 (1.11) | 1.75 (0.05) | 1.67 (0.55) | 4.30 |
Painometer v2 | 2.65 (0.53) | T3 | 2.10 (1.30) | 3.25 (0.58) | 2.33 (0.58) | 2.93 (0.69) | 1.75 (0.82) | 1.00 (0.00) | 4.10 |
Chronic Pain Diary | 2.61 (0.58) | T3 | 2.40 (0.55) | 3.38 (0.03) | 2.00 (0.00) | 2.64 (1.50) | 1.50 (0.58) | 1.83 (0.41) | 3.20 |
Pain Score | 2.41 (1.59) | T3 | 1.60 (0.89) | 4.75 (1.00) | 2.00 (0.00) | 1.29 (1.50) | 1.00 (0.00) | 1.00 (0.00) | 3.50 |
Pain Treatment | 2.36 (1.35) | T3 | 1.20 (0.02) | 4.25 (0.50) | 2.33 (0.58) | 1.64 (1.21) | 1.38 (0.50) | 2.33 (0.82) | 3.00 |
PainTrakr | 2.17 (1.04) | T3 | 1.90 (0.55) | 3.63 (0.50) | 2.00 (0.58) | 1.14 (0.95) | 1.38 (0.04) | 1.33 (0.03) | N/A |
Pain Tracker HD | 1.74 (0.14) | T3 | 1.70 (0.55) | 1.88 (0.50) | 1.83 (0.58) | 1.57 (1.29) | 1.13 (0.50) | 1.42 (0.75) | 1.00 |
aT: tertile. Tertile legend: T1: best-rated apps; T2: average apps; T3: worst-rated apps.
bA: Engagement; B: Functionality; C: Esthetics; D: Information; E: App subjective quality; F: App specific.
cN/A: not applicable.
Differences in the mean MARS (Mobile App Rating Scale) scores between tertiles.
This paper presents a systematic search and evaluation of apps related to pain in the App Store and Play Store. First, it is important to note that the mobile app market is very volatile, unpredictable, and constantly changing, and it is likely that the situation at the time of publication of this paper is not exactly the same as the one presented here. Indeed, during the completion of this study, we detected some changes in the market. Specifically, we had to remove an app from our study because it no longer worked (or even existed in the store) when we tried to use it again to solve some doubts over its rating. Despite this, we present here what, as far as we are concerned, are the most accurate results regarding the quality of the pain apps available at present because it includes an assessment using a validated tool such as the MARS.
Before discussing the scores obtained and the quality of the apps in general, there are some aspects that we would first like to highlight due to their importance in the scientific field: the theoretical support of the apps and the need for randomized controlled trials to test them on people. There is one specific item in the MARS assessing the “evidence base,” which explores the extent to which the app has been scientifically tested. Although the results of the MARS are shown in terms of dimensions and not specific items, it is important to mention here that only two of the apps (Manage My Pain Lite & Pro and Painometer v2) had been tested or trialed to some extent, showing positive or partially positive results. Surprisingly, the latter is not very well positioned in terms of its score on the MARS (it belongs in the worst-rated apps tertile), for reasons that will be discussed later. However, above other criteria, it is crucial for a health app to be tested if it aspires to become a useful tool for health professionals and patients, ensuring safety and good functioning. This is particularly important when dealing with new technology, as discussed in the Introduction [
Another important issue to bear in mind is security and privacy. A recent article by Papageorgiou et al [
An ideal app, apart from being based on scientific evidence and respecting the law and privacy, should be user friendly, attractive, simple, and functional, and exploit the sensors and other capabilities of the devices for the benefit of the patient. However, we already argued in the Introduction that the use of certain technologies or apps could sometimes be harmful, although a recent review by Lee et al [
Regarding the quality of the apps included in this study, we can say that they are mostly good, although the best scores correspond to technical aspects of the app itself, such as “functionality,” while the worst relate more to what is offered to the user and their opinion (“information” and “app subjective quality”). This means that the apps seem to be more or less well designed but fail to fully convince the users. Surprisingly (and apparently in contrast to the previous statement), we observed in our sample that 68.75% of the users’ ratings (via the stars system) in the corresponding stores were higher than those obtained with the MARS. However, it is a single and completely subjective score based on the criteria of the users themselves compared to the result of having applied a validated assessment tool whose results are more reliable. In any case, our results show that it would be necessary to improve less valued aspects such as the information offered to the user, which turns out to be a crucial aspect in this kind of app.
It is important to note that some apps are very specific or perform a single task and this could lead to a decrease in their score in the MARS. It is necessary to bear this in mind when making a critical reading of the classification of the apps that we present here. Some of them might be worse rated not because they were actually worse, but because a high score could not be given to some items of the MARS; these apps can still be excellent in other aspects. For this reason, it is important to observe not only the global score (used to determine the tertiles), but the scores in each dimension. In fact, in our sample we found apps that are among the worst rated but have better scores in dimensions such as “functionality” than the best-rated apps. This study does not intend to make recommendations about what app to use, but merely to show reliable information that can be used by the reader according to their own criteria and all the aspects discussed.
In view of this, one might wonder what determines how an app achieves a higher global score. That is, which aspects characterize a highly valued app or make an app more highly valued than another? In a way, the comparison carried out between tertiles can give us some clues about this because it highlights the differences between the three groups. The main differences were found in app subjective quality, engagement, and esthetics, so these should be the aspects to improve in order to “climb positions” in the app ranking. Nevertheless, in this case, as they are apps intended for health care, these aspects must be secondary, always less important than other relevant aspects already mentioned, such as the scientific basis, security, and privacy.
Finally, this study has the usual limitations of these types of studies, and particularly those due to the nature of the items studied (mobile apps). We highlight the possibility of having missed some pain apps that did not contain the word “pain” in its title or its description. Another possible limitation is that the reliability of the MARS was originally piloted on iPhone apps. However, the same authors state that the scale has been applied to multiple Android apps, finding no compatibility issues. Also, the apps market is constantly changing, and this fact can significantly shorten the validity period of this evaluation. This, in turn, can also be seen as a strength, as this is the most recent update at the time of its publication, and hence the closest approximation to the current situation of pain-related apps. Moreover, unlike other authors, we use an adequate tool to measure the quality of the apps, which is a substantial improvement over previous reviews. Additionally, we include paid apps, which are likely to have different characteristics, options, and ratings, and which are not always included in other reviews, possibly leading to bias.
The pain-related apps that are currently available in the market are of a certain quality, mainly regarding their technical aspects, although they fail to offer information and have an impact on the user. On the other hand, the vast majority of apps are not based on scientific evidence, have not been rigorously tested, and the confidentiality of the information collected is not guaranteed. Future apps would need to improve these aspects, exploit the capabilities of the latest devices, and comply with some other requirements, such as being user friendly, attractive, simple, and functional for the benefit of the patient. These conclusions provide, in our opinion, a more objective perspective than the previous reviews in which no validated tools were used to measure the quality.
analysis of variance
International Association for the Study of Pain
Mobile App Rating Scale
mobile health
The authors want to thank the support of University of Cádiz project PR2017-038.
None declared.