Background and aims. Ecological momentary assessment (EMA) using smartphone apps has been argued to be the gold standard monitoring method in chronic pain. It is unclear, however, whether assessment only or more sophisticated features are required to make EMA with apps relevant in pain practice. 
Method. In this randomized controlled trial, we compare the utility of two app features: i) daily assessment only (EMA condition, n=34), to control for the placebo effect of reporting outcomes daily, and ii) daily assessment including an alarm system that informs physicians when a clinically relevant event occurs (i.e., pain severity and interference remain high despite treatment; EMA+alarm condition, n=41). Study duration was one month. All patients received the usual treatment for their pain. However, patients in EMA+alarm condition also received phone calls in the presence of an alarm, which could lead to changes in their treatment. 
Results. A clinically significant change (CSC; >30% reduction) in pain intensity and pain interference on daily activities occurred, respectively, in 23.5% and 14.7% of patients in the EMA only condition. In the EMA+alarm group, percentages increased to 31.7% for pain severity and 26.8% for pain interference. Response rates were high and similar for the EMA (81.1%) and EMA+app conditions (82.6%). 
Conclusions. Results are encouraging and suggest that the use of an app with clinical alarms (i.e., telemonitoring) might benefit patient outcomes. Another important finding was that EMA via app appears to be feasible, as revealed by high response rates, which should encourage its use in routine care.

DO WE NEED TELEMONITORING IN CHRONIC PAIN? A RANDOMIZED CONTROLLED TRIAL COMPARING A PAIN APP WITH AND WITHOUT CLINICAL ALARMS