Update 3.0.6 has now been released

3.0.6 Release Notes

ADDED – Pain Map Painter – The Eraser tool is back!
ADDED – Pain Map Painter – Drawing path smoothing option. Now enabled by default, this option will reduce the number of points contained within the drawn path while still maintaining the shape of the desired segment. This helps reduce database space and processing time. (Available only on devices running iOS 4.3 and above)
ADDED – Pain Map Painter – Path Overlap Detection. Now enabled by default, this option will scan your pain map to detect any paths that are fully covered by one or more other paths in the drawing. These extraneous paths are then removed to help reduce database space and processing time requirements.
ADDED – JPEG Compression option in Pain Map Painter Tracker. Now enabled by default, the JPEG compression feature greatly reduces the size of the HTML output reports. Up to a 90% reduction in file size has been seen when using the new default setting.
ADDED – Help Confirmation – New users will now get a second pop-up asking if they would like to continue seeing the automatic help screens on each new screen they explore. This has no impact on current users.
FIXED – Comment Tracker – 3.0.5 introduced a bug where a blank comment tracker in an entry would hang the process of generating report data. This is now fixed.
FIXED – Database opening process has been modified to better support schema changes related to software updates
FIXED – Some Diary Entry save bugs

For those of you that want additional commentary on the enhancements, here it is. Enjoy…

  • ADDED – Pain Map Painter – The Eraser tool is back!
    • We had many requests to bring this tool back into the Pain Map Painter, and now we have. The eraser tool enables you to remove any portion of previously painted lines on the pain map model.
  • ADDED – Pain Map Painter – Drawing path smoothing option. Now enabled by default, this option will reduce the number of points contained within the drawn path while still maintaining the shape of the desired segment. This helps reduce database space and processing time. (Available only on devices running iOS 4.3 and above)
    • You probably won’t notice this tool too much as it is designed to reduce the amount of data collected for your painted path, while not affecting the actual shape of the path itself. As an example, a typical painting stroke on the pain map model might consist of 20-30 data points (depending on how many turns and twists you make and how long your finger is left on the screen). The smoothing can often reduce this to 10-15 points which cuts the data in half. This helps both in terms of database storage space and processing time.
    • If you are creating very intricate pain map drawings and notice that the smoothing function is affecting your desired path shapes, you can generally overcome this issue by either using a smaller brush size and/or slowing your finger movement when making curved path segments. Both techniques allow the device to collect more accurate point information that will not be as effected by the smoothing function.
  • ADDED – Pain Map Painter – Path Overlap Detection. Now enabled by default, this option will scan your pain map to detect any paths that are fully covered by one or more other paths in the drawing. These extraneous paths are then removed to help reduce database space and processing time requirements.
    • You will notice this feature when you go to save the Pain Map drawing. You’ll see a progress indicator pop up indicating that the app is Simplifying Path Data. It will do this for both the front and back drawings.
    • Why is this a good thing? We have found that many users were copying their last Pain Map images into a new entry to use as a starting point. Although this is fine in itself, they were often painting over the previous drawing with new paths which added complexity with each time this was done. In some complex pain maps, we saw several hundred paths in a single drawing. This had a major impact on database storage  and processing speed.
    • With the new overlap detection, we are now able to determine if a path is completely covered by other paths. If it is, then it can be removed from the drawing without affecting the final pain map composition. This is a huge optimization when folks are copying their pain maps forward each time. For example, in testing we saw a drawing with more than 700 paths go down to 70 paths after optimization without any impact on the final composition.
  • ADDED – JPEG Compression option in Pain Map Painter Tracker. Now enabled by default, the JPEG compression feature greatly reduces the size of the HTML output reports. Up to a 90% reduction in file size has been seen when using the new default setting.
    • This is another big optimization for our users. Because our reports are very graphics oriented – graphs, pain map compositions, etc, we were seeing HTML file sizes growing very large when some reports were being generated. We have now switched to a JPEG format for the internal graphics which allows for significant compression ratios without much impact on the final images. Because of this, reports that might have become too big to easily email or exchange online have now become quite manageable in size.
  • ADDED – Help Confirmation – New users will now get a second pop-up asking if they would like to continue seeing the automatic help screens on each new screen they explore. This has no impact on current users.
    • When new users begin using Chronic Pain Tracker, we give them the option of seeing a help screen alert describing each new area of the app the venture into. We wanted to make sure this didn’t become too confusing for users, so we give them a second chance to either keep the help screens enabled or disable them so they can explore on their own.
    • We still maintain the option of simply shaking the device whenever you need a help screen to appear.
  • FIXEDComment Tracker Bug – 3.0.5 introduced a bug where a blank comment tracker in an entry would hang the process of generating report data. This is now fixed.
    • This was a bug that slipped by us in the last version. If you selected the Comment Tracker for an entry but then didn’t put any text into the Comment box, and then tried to run a report that included that diary entry, the report process would crash. This is now corrected and we apologize to those of you that had reports crashing because of this.
  • FIXED – Database opening process has been modified to better support schema changes related to software updates
    • As we continue to grow the application, the database schema also needs to change from release to release. This requires the app to update the user’s Diary database to the new schema after they update the software. These enhancements are to help improve the efficiency and stability of that process. It is something you shouldn’t notice as it is all behind the scenes.
  • FIXED – Some Diary Entry save bugs

Testing Medication Effectiveness in Relieving Pain

The Challenge of Evaluating Pain Relief Efficacy

Let’s face it, most people dealing with Chronic Pain take some type of pain relief medication – often multiple types. But do you know if they are really working? And when your doctor suggests trying a new medication to see if it is more effective than your current drug – how can you tell?

Unfortunately, most of the time you can’t objectively say whether one drug is working better than another, or even if either of the drugs is having a real impact on your pain levels. To get truly subjective data on the matter generally requires a laboratory like environment with rigorous data collection processes to ensure that medication intake and pain relief impact is captured on a regular basis. This is just not a realistic situation for most chronic pain folks.

Capturing the Data

However, using the latest analytical tools within Chronic Pain Tracker, you CAN document and analyze this type of data. You and your doctor can now see the statistics describing the reality of your medication and pain interaction over the past month(s), so that you can both make better informed decisions about how to best treat your condition. How does this work? Well, let’s take a look…

When we want to look at medication effectiveness, there are two main sets of data we need to capture:

  • Medication History – what was taken, how much was taken, and when was it taken
  • Pain Intensity – how badly are you hurting and when

 

Both of these data sets are easily recorded using Chronic Pain Tracker. Users are able to create their own customized lists of medications being taken which can record the name, dosage, and date/time of the med being taken. Similarly, recording a current pain level is as easy as selecting from the visual pain indicator scale.

Medication Analysis Window

Another important factor that needs to be considered is the time frame over which the drug is supposed to be effective. For example, many breakthrough pain meds should start to work within about 30 min and last 4-6 hours. Other types of meds may be effective for up to 12 or even 24 hours. And, if you’re dealing with something like a Fentanyl Patch, it may be several days that you need to evaluate.

Medication Entry WindowYou can now specify this effectiveness window period (hours) within the definition of your medication in CPT. You simply enter the number of hours over which you want to analyze the drug’s effectiveness. This value can vary for each medication entry and can be adjusted at any time. The screen image to the right shows the location of this field.

Now, considering the timeframe, it will be important to track your pain levels at the start of taking the medication and then several times over the course of the analysis window period. For example, let’s say that it is 1:00PM and you have just taken a Vicodin. So you create a Diary Entry that records the taking of 1 Vicodin pill and your current pain level (eg. 7). if the analysis window for the drug is 8 hours, then you should plan on creating additional Diary Entries at perhaps 1, 2, 4, 6, and 8 hours after the initial entry where the medication was recorded. There are no hard and fast rules on how many data points you need to capture each time, but its better to err on the side of too much data rather than too little.

The Summary Report Analysis

The magic of the process begins to happen when you run a Summary Report for a particular time period. Let’s say you’ve been testing out Vicodin for the last month and want to get an idea of how it has been working for you. So after following the steps above throughout the month, you’re now ready to produce the Summary Report to review with your doctor.

Summary Report - Medication Taken - Pain Reduction AnalysisBefore explaining what goes on behind the scenes, let’s jump straight to the end result – the Pain Reduction Efficacy graph shown in the Medication Tracker section of the report. You can see a sample of this report on the left. In a normal Summary Report, you would see one of these graphs for each medication listed. This one happens to be a sample for Vicodin 10mg over a 14 day period.

The graph is structured with Time (hours) as its x-axis. The Time represented is the time since the particular medication was taken. So you can see that it starts with 0 hours on the left and goes up to whatever number you plugged into for the Analysis Window – in this case 6 hours.

The vertical axis represents that relative increase/decrease of pain levels over the time period. Each time you take the medication and provide a starting pain level, the app will look for additional Diary Entries that fall within the analysis window timeframe and will check whether your pain level went up or down compared to the starting pain level. This is represented as a percentage value on the vertical axis. The actual data points are shown as the color diamonds on the chart. A green diamond is one where the pain level dropped from the starting point, a yellow represents no change in pain level, and a red shows an increased pain level since taking the medication.

The individual data points are connected by thin gray lines which are shown as a way to see the progression of pain levels for that particular medication cycle. You will also see several diamonds with a thick black border around them. These represent entries where an additional dosage of the same medication was taken. If you start to see clusters of these bordered markers earlier in the analysis window, it may indicate that your medication is wearing off earlier than it should be, and is a good time to raise the question with your doctor.

The thicker blue line shown on the graph is the aggregated pain reduction impact for the medication during the analysis timeframe. This is a great tool for seeing the average effect of the medication on your pain levels. The sample shown illustrates the effect we would expect to see with a medication like Vicodin. After a short period of being digested, the medication begins reducing pain levels over the course of hours 1 to 4. By about hour 5 or 6, pain levels have again returned to their original level and you’re seeing signs that the patient has taken another dose at that point (the bordered diamonds).

Medication Pain Reduction - Sample 2Not all of your graphs are going to follow this idealized curve, there are just too many variables that impact the efficacy of your medications. For example, if you pain normally gets worse towards the end of the day, then a medication taken mid-afternoon will probably show more of a steady-state pain level until it starts to wear off and pain levels rise.

Let’s take a look at a couple other samples based on real world data captured from one of our users. In this first graph, we’re looking at the short acting pain reliever Dilaudid with an analysis window set to 8 hours. As mentioned before, we don’t see the idealized curve from the Vicodin sample above, but that doesn’t mean there isn’t valuable information here.

If we look in the area (A)  on the plot, we see that around hours 3 to 4 there is a large number of bordered markers which indicate that the patient is taking additional doses at those points. This suggests the relief from the medication is not lasting more than 4 hours for this patient. This is further verified with the area (B) where when the patient did go further into the analysis period without taking more medication, the pain levels began to steadily rise over time.

Medication Pain Reduction - Sample 3

The next sample has a longer analysis window (12 hours) for the drug Robaxin. Again, we don’t see the idealized curve, but we can draw some valid conclusions from the graph. In area (A), we’re seeing a short-term increase in pain levels. However, there are very few data points within the first 4 hours of the drug being taken, so we may conclude that the increased pain levels are only due to a lack of data points in the area.

Unlike area (A), when we look at area (B), we see lots of data points which should suggest a more representative view of the drug impact on pain levels. In this period we’re seeing a gradual uptick in pain levels starting at about the six or seven hour mark. Given this increase and the quality of the data here, this probably suggests that the drug is working for roughly the first 6 hours for the patient, but not really beyond that point. It also looks like area (C) is demonstrating that the patient is taking more Robaxin at roughly the 10 hour point. Given the findings in area (B), it may make sense to move the next dose a bit closer say at the seven or eight-hour mark.

Again, you shouldn’t rely on a graph alone to make medical decisions. You should always review the graphs along with your other history factors with your doctor before making any medical decisions. However, we believe that the tools in Chronic Pain Tracker, like the Pain Reduction Analysis, can be an invaluable tool for you to use in your continued care. We hope you find these tools beneficial.

Keeping your private comments private

Example of a Private CommentLet’s face it, if you’re suffering from chronic pain, you deal with some very difficult situations. The non-stop pain, immobility, frustration with our doctors, mental fogginess, etc all combine to really give us a tough time. Often you want to capture those moments or thoughts in your Diary Entry via the Comments Tracker, and that is definitely what it’s there for.

But sometimes, you might hesitate adding comments of a more personal nature, or perhaps comments critical of your doctor or her staff. If you’re supplying your doctor copies of your Diary Reports, you probably don’t want them reading about how you think they don’t know a degenerative disc from a donut. That’s where the comment privacy option comes in.

You may not have noticed, but in the header of the Comment Tracker, you’ll see a small gray lock and key icon. If you click that icon, it will turn into a golden lock that is closed which indicates that this comment is flagged as a private comment. By default, private comments will not be included in either the Diary History or Summary Reports. The reports will still identify that a comment was made in the Diary Entry, but it will only show the content as “[Private Comment]” as shown in the example reports below.

Example of Private Comment in Diary History Report

Example of Private Comment in Diary History Report

Example of Private Comment in Summary Report

Example of Private Comment in Summary Report

General Comment Tracker Privacy Setting

 

Now as handy as that is, we recognize that there may be times when you DO want to include the private comments in the report output. Perhaps you’re generating the reports for your only personal review or something. Regardless of the intent, the feature is available to you.

Simply go to the Setting Tab, Diary Preferences, and then General Comments. In the Reporting Generation Options section, you’ll see a switch labeled “Show Private Comments?” Setting this switch to YES will ignore the privacy settings and will include the private comments in the report. Just make sure you set it back to NO before you export that next report to your doctor!

Please note that to take full advantage of the Comment Privacy option, you need to use Chronic Pain Tracker v3.0.5 and up.

Chronic Pain Tracker v3.0.5 is now available

Today we are releasing v3.0.5 of Chronic Pain Tracker. We encourage all current users to upgrade to this version.

This update includes a couple new features plus several bug fixes, including:

3.0.5 Release Notes

  • ADDED – New Pain Location Map template for migraine headache pain tracking
  • ADDED – General Comment preference flag to either show or not show comments marked as private in Diary History and Summary Reports
  • FIXED – When using the Open/Close buttons during the display of a Summary Report on slower devices, the app can appear to hang. It will now show a progress indicator while the app processes the request.
  • FIXED – Intermittent bug where database would not load properly on startup following the upgrade to 3.0.4
  • FIXED – Intermittent bug where App crashes when selecting a report type in the report selection window
  • FIXED – Bug where Database error is generated when trying to define a new Tracker Collection template item
  • FIXED – Diary Entry cell date/time values could sometimes appear out-of-order in the History view when scrolling through history
  • FIXED – Diary History report is not honoring the General Comment privacy flag

For anyone suffering with Migraine related pain, we’ve added a new template in the Pain Location Mapper that provides an enlarged area of the head and neck so that you can more easily document the location of your migraine pain. The template works the same way as the other male/female templates already existing in the app.

We have also cleaned up a feature originally included in the 3.0 release which is a private comment option. We’ll have more on this feature in an upcoming Post here.

As for the bug fixes, this release should take care of any known issues we’ve seen from our users. if you are having any additional problems with your copy of Chronic Pain Tracker, please let us know. Our goal is happy customers, so if things aren’t working for you, let us know.

Consistent pain? Make entries simpler with “Copy Last”

Copy Last button in Tracker headerFor many of us, the locations and descriptions of our pain may not change too much from hour to hour or even day-to-day. In those cases, you can make the process of creating a Diary Entry more efficient by using the “Copy Last” functionality we’ve built into Chronic Pain Tracker. Let’s take a look at how it works…

One of the easiest ways of using this functionality is to use the Copy button that is included in the header section of each Tracker item. When you tap the button, CPT searches for the last entry using this Tracker and copies that data forward into your current entry. It can be a nice time saver during the entry process.

You’ll find that same Copy Last button in the header of every Tracker item, so whether it is Pain Descriptions (as shown in the image) or Pain Treatments, or Pain Locations, etc you’ll have the ability to copy your last entry’s data forward into the current entry.

Settings - Diary Preferences - Pain DescriptionIf you find that you are consistently using the Copy Last button, you can set that Tracker to automatically apply the Copy Last function whenever you use that Tracker. Basically, you’ll get a Tracker item with data already loaded rather than an empty Tracker whenever you use it in a Diary Entry.

To set this up, you need to go to the Settings tab and into the Diary Preferences section. Now select the Tracker you wish to adjust and look for the”Default from last entry” switch. Set it to ON and you’re all set. Next time you use this Tracker, it will automatically copy the info from your last entry.

I hope this tip helps those of you with consistent pain patterns to be more efficient in your use of Chronic Pain Tracker.