Chronic pain is a highly prevalent condition that is estimated to affect as many as 20% to 30% of individuals internationally [1,2]. Pain is distinguished as chronic when it lasts for ≥3 months [3]. Treatment for chronic pain can vary significantly, with approaches ranging from pharmacological interventions (eg, analgesics and opioid therapy) to nonpharmacological, alternative interventions (eg, cognitive behavioral therapy and physiotherapy) [4]. Chronic pain care and treatment can be particularly complex, as mismanagement can lead to significant adverse effects, such as opioid dependency [5]. Research contributing to the safe, effective treatment of patients with chronic pain is essential to reduce issues around mismanagement of chronic pain.

Due to its prevalence, pain is one of the main reasons why people seek health care [1]. This has resulted in a significant economic impact, with estimated costs of chronic pain to the economy reaching billions around the world [6-8]. Moreover, the COVID-19 pandemic has exacerbated these economic challenges, as health care resources were diverted from chronic pain care to more emergency situations [9]. Certainly, this combination of challenges has led to a reconsideration of traditional methods of care for chronic pain and has highlighted the importance of being flexible to more novel methods of health care delivery [10-12].

One of the ways in which chronic pain care can be addressed innovatively is through digital health technology (DHT). DHT can provide a unique opportunity to mitigate the challenges of chronic pain care in a cost-effective manner [9,13]. In this review, the term digital health will refer to all digital, electronic, and computer technologies to improve health, including eHealth, mobile health, telemedicine, or telehealth [14,15]. As definitions of digital health are continuously evolving and there is no universally accepted nomenclature, such terms are often used interchangeably in the literature [14,15]. Components of DHTs used for chronic pain may include mobile or tablet apps, web applications, wearable health technology, artificial intelligence, and telemedicine. Such DHTs can be used for the purpose of chronic pain self-management [16] or digitally delivered physical therapy [17]. DHT may be particularly beneficial for chronic pain care, as it addresses some of the aforementioned challenges by offering remote care and reducing the impact in certain areas of health care service provision, for example, lack of resources, waiting lists, and limited availability of the health care workforce [18,19].

Health care professionals (HCPs) are essential to effective chronic pain care; specifically, HCP involvement on a multidisciplinary level is integral to quality chronic pain care [2,20]. Furthermore, it has been suggested that chronic pain must go beyond simply multidisciplinary care and be targeted more holistically through interdisciplinary care, which denotes a more specific coordination of care and communication between HCPs from different disciplines [21]. Chronic pain is thought to have a biopsychosocial cause; therefore, care is best targeted through the coordination of the biological, psychological, and social factors contributing to the condition [22]. Moreover, primary care clinicians are thought to be especially important to effective chronic pain care [20,23]. Despite this, much of the literature on DHTs for chronic pain focuses on systems solely intended for patients (for self-management) without HCP involvement. HCP involvement has also been highlighted as an important factor and facilitator in the adoption of DHT, particularly as collaboration with key stakeholders in co-design is essential for the development of usable systems for sustainable implementation [24].

Previous studies on the perspectives of HCPs have also underlined the potential of DHT as a useful tool, for example, for HCP education and patient follow-up [19]. DHT, which targets HCP education, may have particular utility in improving chronic pain care, as negative attitudes and a lack of knowledge have been identified as significant barriers in chronic pain management [25]. In addition, national guidelines for chronic pain care state that HCPs must have the best possible resources and support to manage patients, which could potentially be supported by DHT designed for HCPs, that is, professional-facing systems [23].

Previous reviews on DHTs for chronic pain have focused primarily on determining the effect on patient outcomes, with many of the investigated interventions being patient facing (ie, designed for the use of patients) for the purpose of self-management [18,26-29]. The results of these reviews show that DHT has positive outcomes for patients with chronic pain, such as reduced pain intensity, improved quality of life, coping skills, and adherence to exercise [18,26-29]. Although these reviews highlighted the utility of patient-facing DHTs to improve chronic pain management, it is equally important to focus research on and gain a more in-depth understanding of professional-facing DHTs. DHTs for HCPs in chronic pain care may help ensure evidence-based care and adherence to best practice guidelines, which would ultimately improve patient outcomes. Certainly, DHT for the use of HCPs in the management of chronic pain exists, for example, for clinical decision support (CDS) [30]. One previous scoping review investigated DHTs for musculoskeletal care available in the allied health industry but did not focus on chronic pain or nonallied health industry professionals [31]. However, to our knowledge, no previous reviews have investigated the available professional-facing DHTs for the care of patients with chronic pain.

The question this scoping review will address is what professional-facing DHTs (ie, designed specifically for the use of HCPs) are available for the management of chronic pain?

Specific objectives include the following:

A systematic scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews [32] and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement for scoping reviews [33]. The completed PRISMA-ScR checklist is available in Multimedia Appendix 1.

The protocol for this scoping review was published in JMIR Research Protocols [34]. As this is a scoping review, PROSPERO registration did not apply.

The inclusion of studies was guided by the population, concept, and context framework in accordance with the guidance in the JBI methodology for scoping reviews. A more detailed overview of the eligibility criteria following the population, concept, and context framework can be found in the study by McCartney et al [34].

Comprehensive search strategies were developed using subject headings specific to the databases MEDLINE, Embase, CINAHL, PsycINFO, and Inspec (Multimedia Appendix 2). Search terms for chronic pain were developed using the terms used in the National Institute for Health and Care Excellence guidelines for the care of chronic pain among adults [35]. Further details regarding the development of search strategies can be found in the study by McCartney et al [34].

Search strategies were implemented in each database, duplicates were subsequently removed, and final search results were uploaded onto Covidence (Veritas Health Innovation Ltd). Two independent reviewers (HM and AM or MI) screened the titles and abstracts of the initial search results against the eligibility criteria. Following this, full texts of potential studies identified were screened again by 2 independent reviewers (HM and AM or MI). Authors of the studies that were unavailable were contacted to request access. Conflicts in both screening stages were resolved first through discussion and then through a third independent reviewer (HKR, NMW, or RM). Backward citation screening was also completed.

Data extraction and quality assessment of 20% (10/52) of the included studies were completed by 2 independent reviewers (HM and AM). As the rate of agreement between the 2 independent reviewers (HM and AM) for data extraction and quality assessment was high at 97% and 97%, respectively, 1 reviewer (HM) completed the rest of the data extraction and quality assessment work. The data extraction tool was adapted from the Template for Intervention Description and Replication (TIDieR) checklist [36], and the quality assessment was conducted using the Quality Assessment for Diverse Studies (QuADS) tool [37]. The adapted data extraction and quality assessment tool is available in the published protocol [34].

Qualitative analysis methods were used to address review objectives 3 and 5. An inductive qualitative content analysis method was used to code the user features of DHTs reported in the included studies and group these codes into main category themes through a process of abstraction [38]. HCP perspectives, as reported by the included studies, were analyzed using the thematic synthesis method of extracting qualitative results, grouping codes into descriptive themes, and subsequently developing analytical themes, as reported by Thomas and Harden [39]. In accordance with this method, quotes presented in the Results section are direct quotes of study participants or key concepts and findings as reported by the studies. Qualitative analyses were conducted on NVivo (Lumivero) by HM and cross-checked by coauthors (AM, RM, HKR, and NMW).

The initial search identified 7127 studies, of which 1836 (25.76%) were duplicates and subsequently removed. After screening full texts and backward citation screening, 52 studies reporting 44 DHTs were included. Reasons for exclusion are detailed in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart (Figure 1).

QuADS [37] was applied to 46 (88%) of the 52 included studies. The remaining 6 (12%) studies were descriptive reports of the DHTs; therefore, QuADS could not be applied due to a lack of participant involvement and data collection [40-45] (as the QuADS criteria include description of target population, sampling approach, etc). The mean QuADS score was 22.7 out of 39 (SD 5.3), and the range was from 7 to 33. The criterion with the lowest quality score was “justification for analytic method.” Most (n=41, 89%) included studies did not provide a rationale for their chosen analyses, with the exception of 11% (5/46) studies [46-50]. Another criterion of lower quality was “evidence that the research stakeholders have been considered in research design or conduct,” with most (39/46, 85%) studies scoring 1 (out of 3) or below, apart from 15% (7/46) studies that described more substantial stakeholder collaboration in both the DHT development and planning of the research [49,51-56]. The criteria with the highest quality assessment scores were in reference to the appropriateness of study design and statement of research aims. The individual QuADS scores for the 46 included studies are available in Multimedia Appendix 3 [40-91].

The 52 included studies of this scoping review were varied in their characteristics; further details regarding individual studies and DHT characteristics can be found in Multimedia Appendix 4 [40-91] and Multimedia Appendix 5 [40-91].

Many of the studies included in this scoping review did not focus specifically on the development of the DHTs. Less than half of the DHTs (20/44, 45%) were reported to have been developed with any stakeholder involvement, with most of the reporting studies (16/52, 31%) lacking specific details regarding the level of involvement. With regard to specific stakeholders involved in the DHT development, 34% (20/52) studies reporting 34% (15/44) DHTs described some HCP involvement [45,48,49,51,52,54-60,63,66,68,70,79,80,84,89]; 25% (13/52) of the studies reporting 25% (11/44) of the DHTs described some patient involvement [48,51,53,54,58,59,66,68,70,76,79,80,89]; 7% (3/52) of the studies reporting 7% (3/44) of the DHTs described some nonspecified “stakeholder” or user-tester involvement [40,60,76]; 9% (5/52) of the studies reporting 9% (4/44) of the DHTs described some other stakeholder involvement (eg, pain specialists or researchers, technical experts, and software engineers) [58,59,67,87,89]. Although stakeholder involvement in the development was briefly mentioned in these latter studies, few (9/52, 17%) studies reported any detailed or thorough co-design process. Notably, the development of only 11% (3/44) of the DHT solutions was reported to have been led by a system development framework [45,52,54,63], which was the analysis, design, development, implementation, and evaluation framework [92]; the Good Things Foundation pathfinder model for digital health inclusion [93]; and the Johns Hopkins University tool for development of clinical applications [94]. Only 4% (2/52) of these studies reported the use of a framework that focused specifically on digital health system development [52,54]. No studies reported the use of frameworks to guide both the intervention and system development. In total, 4% (2/52) of the DHTs were described to have been developed using the principles of user-centered [80] or decision-centered [55,57] design, but no specific frameworks were mentioned.

Due to the significant heterogeneity of aims and design of the included studies, there was also significant variation in the outcomes measured. Less than half (24/52, 46%) of the included studies focused on outcomes related to the HCPs (eg, HCP perspectives on the DHTs and rate of DHT use) [44,50,53-55,57,60-64,66,67,69-71,73,78-80,82,84,89,91]. In addition, 2% (1/52) of the studies reported measuring HCP-related outcomes on DHT user experience but did not specifically report the results [52]. There were some studies that focused solely on patient outcomes (eg, clinical patient characteristics of change in pain intensity, quality of life, and physical activity or intervention efficacy and adherence or patient perspectives on the DHT; 14/52, 27%) [51,56,58,59,65,68,72,74,75,77,81,85,86,90]. Cost-effectiveness of the DHT implementation was also measured as an outcome in 6% (3/52) of the studies included in this review [46,47,76].

To our knowledge, this is the first scoping review to systematically investigate professional-facing DHTs for the care of patients with chronic pain. This scoping review identified that various professional-facing DHTs to support chronic pain management exist, with 52 of the included studies reporting 44 of the DHTs aimed at RPM, CDS, assessment and diagnosis, and HCP education (or a combination).

The first objective was to investigate the components of professional-facing DHTs, which varied significantly. The most commonly targeted population and setting of DHT use were multidisciplinary teams of HCPs for the care of arthritis (various types) in primary care. Over half (26/44, 59%) of the reported DHTs have a connected patient-facing interface, mostly for the purpose of RPM through patient-reported data collected on self-management mobile apps. The second objective was to investigate the methods of DHT development; many of the included studies did not specify this. Less than half (20/44, 45%) of the DHTs were reported to have been developed with any form of stakeholder involvement, and fewer (7/44, 16%) DHTs were reported to have been developed with enough stakeholder involvement to constitute proper co-design. The third objective was to analyze the user features of the available professional-facing DHTs. The user features support the HCPs in duties to guide initial consultation with patients, support chronic pain management for patients (including management of opioid intervention and risk), facilitate ongoing patient management following initial consultation (including management of PROs), and support more routine tasks, that is, daily tasks that can occur outside of patient-professional interaction. The fourth objective was to provide an overview of the outcomes of the studies reporting the available professional-facing DHTs, which differed significantly across the included studies. Notably, less than half (24/52, 46%) of the included studies reported specific, professional-related outcomes, and some (14/52, 27%) focused solely on PROs. Finally, HCP perspectives suggested that the DHTs must fulfill the requirements mentioned subsequently for successful implementation in practice. The DHTs must have additional value to the HCP, must easily integrate into the clinical workflow of the user, and must be easy to navigate, and HCPs must be able to trust the DHTs.

The findings of this review are in line with previous literature that focuses on digital health for professionals in health care. DHT has many benefits for HCPs, as it reduces clinical workload while enhancing work efficiency, therefore providing both financial and operational advantages [98]. Previous literature has highlighted DHT as a solution to mitigate some of the issues surrounding chronic pain management, such as limited resources for care [18,19,23]. This has been of particular value in the post–COVID-19 pandemic world, where health care services have been strained [98]. Digital health provides unique opportunities for HCPs, as a large proportion of the world’s population has access to the internet and smart technology, opening new possibilities for remote monitoring of patients [99]. Remote monitoring may be one of the main ways that DHT can provide benefits to both the HCP and patient, as it could improve professional efficiency [98], which consequently would have an impact on patient outcomes. The potential of remote monitoring through DHTs is clearly a focus for exploration in digital health research on chronic pain. This is supported by the findings of this review in several ways. First, many (22/52, 42%) of the reported DHTs were designed primarily with the aim of RPM. Second, most (26/44, 59%) of the DHTs had a connected patient-facing interface that could be used to monitor patient progress. Third, the main outcomes measured by the DHTs were PROs. Fourth, the analyses of the DHTs resulted in a category of user features that can aid the HCP in facilitating ongoing patient management, particularly through management of PROs. Fifth, the synthesis of HCP perspectives showed greater visualization of comprehensive patient information as a factor that would encourage professionals’ use of DHTs, which would be most significant in the remote monitoring of patients.

Indeed, it is important to take into consideration the needs of the HCPs when considering chronic pain care [100]. Professional acceptance of DHT has been suggested to be influenced by the amount of time or work required to use the system and the relevance of system information [101], which aligns with the results of this review. This review highlighted that HCPs place importance on the ability of the DHTs to easily integrate into the clinical workflow and the trustworthiness of the DHTs, which is in concurrence with the reasons for professional acceptance as reported by previous literature [101]. For the most part, HCP perspectives were similar across the included studies with regard to the factors affecting their use of DHTs, despite the significant heterogeneity in the types of DHTs they were considering. This general agreement suggests that these factors should be taken into consideration when designing any DHTs for HCPs. Such factors that affect professional acceptance of DHT use in chronic pain care are reflected in the literature focusing on other areas of digital health care; previous research on other conditions, such as chronic obstructive pulmonary disease and hypertension, has highlighted facilitators of HCP use of DHTs, including ease of integration into the clinical workflow [102], high usability [102,103], and the additional value of the solution (for greater access to patient data and to increase patient engagement and communication) [102,104,105]. However, despite research being conducted on HCP perspectives on digital health, professional-facing DHTs may not be meeting their full potential of benefits due to a lack of HCP acceptance and design input [106]. This may indeed be the case for the available DHTs identified by this review, as the level of HCP input into the design was inconsistent across the literature.

The idea that there is a further, unmet potential of DHT that is directed at HCPs to support chronic pain management is reinforced by several findings of this review. Although this review testifies not only to the availability but also to the variety of professional-facing DHTs, few DHTs that were identified would improve the provision of holistic and interdisciplinary care. In fact, only 1 of the DHT solutions supported a feature that would allow HCPs to communicate with one another to coordinate care [76], despite the main target HCP population for DHT use being multidisciplinary care teams. As mentioned earlier, digital health is explored as a method to complement traditional care as it introduces the potential opportunity to mitigate some of the challenges surrounding chronic pain care, such as a lack of resources [18,19]. The literature on chronic pain care emphasizes the importance of holistic care, particularly as the evidence from research suggests biopsychosocial mechanisms of chronic pain [22]. The lack of resources is a major reason why many individuals with chronic pain are unable to access the specialized care that would promote evidence-based, interdisciplinary, and holistic management, which is seen as the most ideal standard of chronic pain care [21,23]. DHT may provide a solution to this issue and be one way to make interdisciplinary care more accessible in the future. Certainly, DHT for professionals in health care is important to support evidence-based practice for HCPs and subsequently improve patient outcomes.

It is accepted that the involvement of stakeholders, particularly HCPs and patients, in the design of DHTs is important for ensuring usability and successful implementation in health care practice [107-109]. Despite the recent rise in digital innovations for chronic pain [52] and the abundant availability of professional-facing DHTs as demonstrated by this review, much of the research supporting DHT development still lacks adequate reporting of appropriate stakeholder involvement. Over half (24/44, 54%) of the DHTs included in this review were developed without any form of collaboration with stakeholders. Furthermore, the quality assessment of the included studies identified involvement of stakeholders as a criterion of low quality. All of this suggests that the literature in this research area is still suboptimal, as it lacks consistency in the reporting of digital health development. For standardization in the reporting of digital health, the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist [110] was created and is occasionally consulted by clinical trials of DHTs; a criterion within this checklist is “describe the history/development process.” It is clearly important to be able to access information regarding the specific development process of DHTs. This is a criterion that many of the studies included in this review would fail to meet. This may also be due to the CONSORT-EHEALTH checklist being a guide for randomized controlled trials in DHT research, which most (47/52, 90%) of the included studies are not. To our knowledge, no guidelines exist for the standardization in the reporting of studies to develop DHTs, which mostly use qualitative methods. This may be a major reason for inconsistencies in the literature on the reporting of DHT development.

Although necessary due to its complexity, digital health in general often lacks stakeholder involvement, consequently limiting its adoption [107]. Again, this may be due to a lack of guidance on how to adequately use co-design in digital health research [107]. Co-design refers to a method essential in DHT design, which involves direct and active involvement of stakeholders (most importantly, the end users) in the whole design process from the early stages of conception [107-109]. This method is not consistently described or evaluated in the literature [111], which is reflected by the studies included in this review. For the most part, the studies that did describe some level of stakeholder engagement in the DHT development did not consistently report methods that met the co-design criteria of active collaboration across the whole process from design planning and conception. Although this suggests that these studies did not practice proper co-design in their DHT development, it may also be that the studies did not adequately report the involvement of stakeholders. The challenge of properly applying co-design methods in digital health research is thought to be due to high HCP workload, resulting in a lack of time for sufficient active involvement [108]. However, increased time and effort for co-design application could lead to adoptable DHTs, which can eventually improve work efficiency for professionals [98], which in turn will inevitably have an impact on both professional and patient outcomes.

The results of this review show good availability of professional-facing DHTs. However, the methods of DHT development are still lacking due to several reasons. First, it is unclear from the included studies whether any of the DHTs were developed through methods that adequately meet the standards of proper co-design; second, there is no evidence to suggest that any of these studies followed specific frameworks to guide both the intervention development and the system development. The use of frameworks would ensure that the design methods are rigorous to result in a DHT that is evidence based, with reliable clinical information and high usability. Both are equally important to consider for DHTs and should adhere to the principles of co-design through adequate involvement of end users. HCP perspectives of this review also strengthen this argument, as the ability for the professionals to trust the DHTs to provide clinically accurate information and usability were highlighted as factors that would encourage the use of digital health for chronic pain care. Focusing on the rigorous development of the intervention and the background system through the use of frameworks would result in the fulfillment of the latter factors. For intervention development, frameworks exist, such as the Medical Research Council framework, which highlights the importance of iterative and rigorous development through an evidence-based approach of research and stakeholder engagement [112,113]. Iterative development has also been highlighted as particularly useful for improving the usability of DHTs [114]. Models that focus specifically on user-centered principles of DHT development, such as the Centre for eHealth Research Roadmap, also exist to guide system development [115]. These types of system development frameworks are beneficial to DHT research, as they focus more on usability. Future research on the development of professional-facing DHT should use rigorous co-design through active involvement of stakeholders from the beginning of the process and may also benefit from using intervention- and system-focused frameworks, which encourage co-design principles. This will help in ensuring evidence-based assistance for professionals, increased usability, and consequently, more sustainable adoption of DHTs.

In general, future research should also focus more on how DHTs can help HCPs in providing chronic pain care. There is a clear interest in the potential for DHTs to improve chronic pain care from the professional perspective, as demonstrated by the rationale supporting the studies included in this review. However, much of the literature still focuses more on the patient perspective; most (28/52, 53%) of the studies included in this review did not measure professional outcomes, focusing more on the connected patient-facing DHTs. Future research on professional-facing DHTs should also ensure to measure professional outcomes and not just patient outcomes, for example, HCPs’ use of DHTs. Moreover, there are many literature reviews that focus on patient-facing DHTs, but few exist on professional-facing DHTs for chronic pain management. This scoping review was the natural first step to conducting further research on this topic. To our knowledge, there are no systematic reviews that investigate the effectiveness of professional-facing DHTs for improving chronic pain care. As per the guidance in the JBI Manual for Evidence Synthesis [31], a scoping review, which focuses on intervention availability, forms the previous step to a systematic review, which focuses on intervention efficacy. A systematic review may be necessary in the future to fully investigate the effectiveness of DHTs for HCPs in chronic pain health care.

As discussed, the available DHTs for professionals in chronic pain care are heterogeneous but may not necessarily meet the full potential for aiding HCPs due to a lack of professional acceptance and design input [106]. In addressing the objectives of this scoping review to investigate the professional-facing DHT components, user features, and HCP perspectives, several gaps were identified that could be addressed to improve chronic pain care practice through digital health.

The lack of focus on providing holistic chronic pain care suggests that there is a potential gap for a professional-facing DHT solution that supports interdisciplinary care of chronic pain, allowing greater coordination of care and communication between multidisciplinary HCPs. The most commonly targeted setting for DHT implementation in this review was primary, which is where most chronic pain conditions are cared for in the United Kingdom [23,35,116] and around the world [20]. Perhaps the impact of chronic pain is greatest on primary care, especially economically, which is a significant burden [116]. There may be an unmet potential in DHTs to support primary care more comprehensively or improve interdisciplinary care of chronic pain. However, context is also important to consider for future developers, as the areas of care in which chronic pain has the greatest burden may be variable depending on the health care system of the country.

Despite professional acceptance being essential, some of the system components of the reported DHTs conflict with the themes highlighting HCP perspectives. Most (34/52, 65%) of the included studies reported their DHTs to be standalone or did not mention an ability to integrate into larger, existing systems; however, the thematic synthesis highlighted integration into the current clinical workflow of the professional as a factor that would encourage the use of DHTs. Indeed, some DHTs may have this ability to integrate even if the included studies did not report this. The lack of the ability to integrate, exhibited by many of the existing DHTs, is actually emphasized as a factor that inhibits wider clinical use in studies included in this review due to inconvenience to the HCP [87]. For optimal application of professional-facing DHTs in practice, future DHTs may be best developed with the ability to integrate into existing systems to ensure easier assimilation into the clinical workflow of the end user professional. Similarly, despite the trustworthiness of DHTs being valued by HCPs, few (6/52, 12%) studies reported any details regarding security and privacy. This is extremely important for the adoption of any professional-facing DHT solutions in practice because such systems will likely contain sensitive patient data that require protection. Developers of such systems should consider the factors inferred from the thematic synthesis of HCP perspectives on the use of DHTs for chronic pain management, ensuring that the system has additional value, integrates into the clinical workflow, is easy to navigate, and promotes professional trust in providing quality care.

This is the first scoping review to investigate professional-facing DHTs for the care of patients with chronic pain. It is also the first review to conduct an analysis of the user features that support HCPs in chronic pain care through digital health as well as the first to thematically synthesize HCP perspectives on the use of DHTs specifically designed for professionals. Therefore, it is likely that this review is the most comprehensive report of chronic pain–specific DHTs that support professionals in health care. A major strength of this scoping review is the systematic process used to screen reports for inclusion. A comprehensive search strategy was cross-checked by an academic librarian, and results were screened by 2 independent reviewers for study inclusion. Furthermore, this review followed the scoping review guidelines set by the JBI and PRISMA to ensure rigor. Therefore, it is likely that most of the literature that supports professional-facing DHTs for the care of patients with chronic pain was captured by this review.

However, several limitations of this review exist, which may have resulted in some relevant articles being missed for inclusion. First, the search was limited to studies written in the English language; therefore, systems from non–English-speaking countries may have been missed. This is particularly important to note as a limitation, because there was significant variability in the countries the available DHTs were developed and designed for application in the health care systems of; other studies that report on updates or adaptations of the included DHTs may be reported in non-English languages. In addition, the search was limited to academic databases and excluded gray literature, and DHT solutions may be developed commercially or without publication of peer-reviewed research. Nonetheless, the interest of this scoping review was the availability of interventions that are evidence based and therefore more likely to be implemented in real health care settings. This review showed that many of the studies reporting professional-facing DHTs focus primarily on the connected patient-facing DHTs and their impact on patient outcomes, with little information regarding the professional interface. Thus, there is a possibility that other relevant studies may have been excluded during the screening process due to a lack of focus on the HCP and resultant absence of information on the professional-facing DHTs in the abstract. Finally, some relevant studies may have been missed due to the nomenclature of chronic pain. There is some variability in the chronic pain literature on how the condition is defined, that is, how long pain must be experienced before “acute pain” turns to “chronic pain” [117]. This review used the International Classification of Diseases, 11th Revision guidelines of pain experienced for ≥3 months, or if reported by the authors specifically as “chronic,” to assess eligibility. Some relevant studies may have been missed in the search if any other definition of chronic pain was used or if they did not specifically report that the DHT was for chronic pain care.

This scoping review is the first to investigate the availability of professional-facing DHTs in the care of patients with chronic pain. There is a clear interest in DHTs for chronic pain care for use by HCPs, as highlighted by the availability and variability of such solutions. However, the focus on professionals in this research area is still limited. There is still some unmet potential in professional-facing DHTs. The interest in digital health research, specifically on remote monitoring of patients, shows an unprecedented opportunity for greater access to and ease of care for both the patient and professional, which can be explored further in future research on DHTs for chronic pain care. Research reporting on professional-facing DHTs is lacking in proper co-design development. Future developers of professional-facing DHTs should consider this when designing a new intervention.