1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
Blockchain, also called as a distributed ledger or shared ledger, is a technology that generates data blocks without an authorized third party and allows participants to jointly verify, save, distribute, and connect the data blocks [1-3]. Its participants, not a centralized server of a specifi c institution, jointly record the data distributed on a P2P network [1-3]. In other words, authorized users access ledgers in a mutually preordained manner, and transactions that follow an agreed protocol are recorded, eliminating the need for a centralized server for safely storing information and a third party for information certifi cation [1-3]. In blockchains, ledgers, which are called nodes, consist of blocks. The application of blockchain technology has been expanded to the fields of government, finance, and public data. Recently, attempts have been made to apply blockchains in medical industries [4,5]. Herein, we suggest the applicability of blockchain technology in the fi eld of pain medicine (Figure 1).
In modern pain medicine, various medical examinations are conducted for an accurate diagnosis, and several types of treatments are provided for an effective and appropriate pain management. Moreover, patients frequently visit many hospitals or clinics for the most effective pain treatment. Medical information or records must be shared between hospitals or clinics to ensure continuous pain treatment. However, currently, patients’ medical information is stored on hospital servers and barely shared among institutions for security reasons. Owing to the insufficient exchange of medical information, patients who visit other hospitals may often have to repeat the same medical tests and may receive ineffective treatments that they already received from a different hospital. Furthermore, patients must manually provide a printed copy of the medical information from their previous treatment institutions, which is inconvenient. In addition, physicians identify the present and past medical state of the visiting patients based on the written records. However, because of the large volume of written information, doctors may spend longer time comprehending medical information and may miss some information. In blockchains, the information generated and recorded on a block is stored in a distributed form, minimizing hacking risks. Hence, using blockchains medical information can be easily and flexibly exchanged between hospitals . Moreover, patient medical information can easily be transferred as soft copies using smart devices when patients visit different hospitals. Simplifying medical information sharing between hospitals can help prevent unnecessary examination and ineffective treatment, and more effective treatment can be accurately provided . Furthermore, drug side effects or medical history can be more accurately recognized by physicians, facilitating safer pain treatment. Implementing a universal format of electronic charts and storing only essential information in blockchains can make patient pain information easier to comprehend and enable continuous pain treatment.
Recently, the use of opioid pain relievers has been increasing for controlling cancer and non-cancer pain . In the past, the use of opioids was infrequent owing to patients’ and physicians’ aversion to them. However, their use has increased because several recent studies have reported that appropriately used opioid pain relievers can improve the quality of life while not causing addiction [8,9]. Simultaneously, the number of prescriptions that misuse/overuse medical opioids is increasing and so is the number of incidences where medical opioids are stolen or lost in hospitals and pharmacies. Furthermore, misusing, overusing, and the illegal distribution of medical opioids among medical personnel, patients, and patients’ guardians are also increasing . To prevent the misuse/overuse and the illegal distribution of medical opioids, hospitals require a comprehensive opioid management system. Currently, medical opioids are stored separately from other types of medicine. A lock is also installed to prevent potential carry-in/carry-out, and management ledgers observing narcotics management regulations are maintained. Following the Narcotics Control Act, the time and amount of dosage and amount in inventory are recorded. However, their credibility and compatibility are undermined by the lack of human resources for managing narcotics and inconsistent data management in hospitals. To manage medical opioids, hospitals can utilize blockchains. Hospitals can use blockchains to integrate the management of medical opioid information to avoid information duplication or mismatch . Additionally, using blockchains to manage the entire process, from receiving medical opioids to generating disposal report statistics, increases the efficiency and accuracy of storing data relevant to the distribution and storage of opioids and data inquiry . Blockchains can simplify the identification of the department or location in which opioid theft or loss occurs, and misuse/ overuse statistics can be rapidly generated to identify problematic clinics.
Furthermore, blockchains can be used for pain-related clinical studies. For example, patients’ case reports or informed consent forms may be stored in blockchains. Storing in blockchains further protects the information of patients participating in clinical studies via the transparent management of the information . Furthermore, this enables research data between collaborators to become easy to share. Storing research-related documents in blockchains enables the management of research participants’ personal information to become safe and convenient.
Blockchains have a lot of different applications in the field of pain medicine. However, for blockchains to be implemented in actual medical industries, various obstacles such as technical disadvantages, social agreements, and immature relevant laws/policies must be addressed. Once these issues are resolved, blockchains can be applied in medical industries, which would be helpful for doctors and patients. Finally, by sharing efficient and transparent medical information, the medical implementation of blockchains will contribute to a safer and healthier society
Storing information of stroke rehabilitation patients using blockchain technology: a software study.
J Yeungnam Med Sci. 2022;39(2):98-107. doi:10.12701/ yujm.2021.01368
Hau YS, Chang MC, Park JC, Lee YJ, Kim SS, Lee JM.
Pediatricians’ perception of factors concerning the clinical application of blockchain technology to pediatric health care: a questionnaire survey [published online ahead of print July 18, 2022].
J Yeungnam Med Sci. doi:10.12701/ jyms.2022.00241
Kuo TT, Kim HE, Ohno-Machado L.
Blockchain distrib- uted ledger technologies for biomedical and health care applications.
J Am Med Inform Assoc. 2017;24(6):1211- 1220. doi:10.1093/jamia/ocx068
Chang MC, Hau YS, Park JC, Lee JM.
The application of blockchain technology in stroke rehabilitation.
Am J Phys Med Rehabil. 2019;98(7):e74. doi:10.1097/ PHM.0000000000001083
Chang MC, Hsiao MY, Boudier-Revéret M.
Blockchain technology: efficiently managing medical information in the pain management field.
Pain Med. 2020;21(7):1512- 1513. doi:10.1093/pm/pnz261
Kim JK, Hau YS, Kwak S, Chang MC.
Essential medical information for stroke patients undergoing interhospital transfer: a Delphi study.
Am J Phys Med Rehabil. 2021;100(4):354-358. doi:10.1097/ PHM.0000000000001573
Hurtado I, García-Sempere A, Peiró S, Sanfélix-Gimeno G.
Increasing trends in opioid use from 2010 to 2018 in the region of Valencia, Spain: a real-world, popula- tion-based study.
Front Pharmacol. 2020;11:612556. doi:10.3389/fphar.2020.612556
Nadeau SE, Wu JK, Lawhern RA.
Opioids and chronic pain: an analytic review of the clinical evidence.
Front Pain Res (Lausanne). 2021;2:721357. doi:10.3389/ fpain.2021.721357
Rosenblum A, Marsch LA, Joseph H, Portenoy RK.
Opioids and the treatment of chronic pain: controversies, current status, and future directions.
Exp Clin Psycho- pharmacol. 2008;16(5):405-416. doi:10.1037/a0013628
Prescription opioid misuse and overuse in the U.S.
Mo Med. 2018;115(3):189-190.
Can blockchain technologies help tack- le the opioid epidemic: a narrative review.
Pain Med. 2019;20(10):1884-1889. doi:10.1093/pm/pny315