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article imageChatbot designed to cure chronic pain: Interview Special

By Tim Sandle     Jul 23, 2018 in Health
Curable is a chatbot-like app that uses a combination of pain science education and evidence-based techniques to address pain. To discover more about this form of AI in healthcare, Digital Journal spoke with John Gribbin, Curable's CEO.
Curable is a chatbot-like app that uses a combination of pain science education and evidence-based techniques to address pain. In trials, 70 percent of users report that they have experienced some degree of relief from their physical symptoms after 30 days of continued use.
In a similar way that chatbots enable someone to quickly find answers when banking or shopping, Curable is designed to be a self-help pain coach. Its chatbot "Clara" acts as a "virtual pain coach", guiding users to connect the dots between what's happening in the brain, in the body and in their life to get a full picture of what's causing symptoms and how to relieve them. All its techniques are backed by science, and include guided meditations, visualizations, and Cognitive Behavioral Therapy techniques.
The app adopts what is termed a "biopsychosocial" approach" to pain. Curable enables a user to adopt this approach anywhere. John Gribbin, Curable's CEO explains more.
Digital Journal: How widespread are chatbots becoming?
John Gribbin: About two years ago, there was a sense in the tech industry that chatbots were going to be the next big thing. This sentiment was especially strong as it pertained to them being hosted on messaging platforms such as Facebook Messenger or iMessage. The difference in the new wave of chatbots is that developers now realize that they must have a clearly defined function. If you can’t articulate exactly why you’ve chosen a chatbot interface rather than a traditional UI, then you should probably not be building one. Today we are seeing better quality and more innovative uses for chatbots than we did just a few years ago.
DJ: What types of applications are chatbots used for?
Gribbin: In my view, the two areas where chatbots excel versus a traditional software interface are routine customer support issues and top-of-funnel marketing activities. However, I also believe there is great potential when it comes to use cases pertaining to children. Given that kids are adept phone users and spend a good deal of time on messaging platforms, they are comfortable with the interface. Chatbot development to meet kids’ needs could become a major area in the future.
DJ: How are chatbots assisting with healthcare?
Gribbin:Where I’ve seen chatbots have the most success in healthcare to date is in the role of simple diagnostic tools. While chatbots may not (and perhaps should not) offer formal medical diagnoses, what they can do well is route online patients through an evaluation of their symptoms, make suggestions on the best next steps and recommend resources that can help take those next steps.
At Curable, we chose a chatbot interface for slightly different reasons. We believe that healthcare is most effective when it’s personalized. This is especially true with pain, because pain is famous for being unique to each person. The Curable chatbot receives inputs from users, then does two things: designs a chronic pain program specifically for that particular user based on the inputs they’ve offered, and continuously reconfigures the program as the user’s needs change over time. In addition, the Curable chatbot learns from the aggregate of users (via machine learning) to get even better at making recommendations for pain relief for each specific user.
DJ: What is the purpose of Curable?
Gribbin:Curable is an online therapy program that helps people with chronic pain. Curable was founded by people with chronic pain and developed in conjunction with researchers and physicians in the field. Our company’s mission is to provide widespread access to evidence-based, safe and effective treatment for chronic pain. The medical definition of “chronic pain” is any pain that lingers beyond 3-6 months. It is well established that as pain reaches this “chronic” state, the brain and nervous system - and not just the part of the body that hurts - play a huge role in the perpetuation of the pain. So for most people with chronic pain, a critical piece of their healing regimen is altogether missing - the piece that involves offering therapeutic attention to the brain.
Curable provides that missing piece, a therapy program for a nervous system in pain, backed by science and testing and delivered in an accessible, safe, convenient, affordable way. For some people, Curable is all they’ve needed all along and they get better by using Curable alone. For others, Curable supplements the work they are doing with physicians and physical therapists and can work in work tandem with prescribed medication.
DJ: How did you test out the chatbot?
Gribbin:We initially launched a non-public beta version of the application in December 2016 and beta tested the product on what ended up being over 600 chronic pain sufferers between January and June of 2017. We stayed very close to our end user during this period, writing code, releasing code, getting feedback from real users, and then continuously repeating the cycle. The feedback phase often took the form of our founding team members on the phone with users for hours.
Aside from the qualitative information we were receiving, our primary quantitative measurement was a Patient Global Impression of Change survey that measured a Curable user’s self-reporting of pain reduction and quality of life improvement. We continued the measurement process until our data began to exceed existing market comps as far as pain reduction and then began marketing the Curable app to the public in June 2017.
DJ: What is a biopsychosocial approach?
Gribbin:The biopsychosocial approach to chronic pain the most widely accepted framework for explaining and treating chronic pain. Basically, it proves that pain is a complex process, rather than just a simple connection between nerves. It demonstrates that pain is an intricate and dynamic interaction among biological, psychological and social factors that can often worsen and perpetuate the sensation of pain. When a biopsychosocial model is not employed in a patient’s chronic pain treatment, the provider and patient too often focus strictly on the “bio,” which includes the structural, genetic, and biochemical aspects.
DJ: What has been the response from the medical profession?
Gribbin:Given how well-accepted it is that the brain plays such a significant role in chronic pain, the scientific and medical communities have received Curable with open arms. Only 34 percent of primary care physicians report feeling comfortable treating people with chronic pain, yet somewhere between 30-40% of all primary care appointments in the U.S. involve chronic pain. So there is a terrible supply and demand breakdown, and doctors are desperate for safe, evidence-based options to offer chronic pain patients.
Currently, we have formal arrangements with over 100 hospitals and clinics around the world that refer their patients to Curable. In fact, about 20% of all new Curable customers come from provider referrals. I believe medical practitioners have been looking for a solution like Curable to come along for quite some time.
DJ: How about consumers? How have they reacted?
Gribbin:We currently have around 30,000 chronic pain patients using our program. After 30 days of using the app, we send out a Patient Global Impression of Change survey for users to document their pain and progress with the program. About 70% of respondents report experiencing some to full relief of physical pain symptoms and about 80% report an improved quality of life - which in many cases is even more important than the physical symptoms. That doesn’t include the many hundreds of incredible stories and testimonials we’ve collected of lives that Curable has changed in a dramatic fashion.
For most people with chronic pain, they don’t simply have pain that lasts for too long, go to the doctor and it’s fixed. Curable provides that missing piece, and in many cases ends the years-long search for relief.
More about Pain management, curable, chatbot, Medical
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