Researchers from the University of Twente, Deventer Hospital and Saxion University of Applied Sciences are working together on a smart solution to a growing problem in healthcare. Patients are being discharged sooner and sooner after major surgery. They leave with a bag full of medication, a leaflet full of instructions, and a lot of uncertainty: Am I taking too much or too little? How can you prevent addiction and ensure effective pain relief? The collaboration led to the development of the PainSafe.
The idea originated somewhere at sea, between Schiermonnikoog and the mainland. Orthopaedic surgeon Dr Ydo Kleinlugtenbelt: "During a conference with general practitioners and specialists on pain medication, everyone recognised the problem. Then I thought, ’There must be a better way.’ With current technology, we should be able to develop something that addresses these problems."
The problem is real. Over the past ten years, the use of oxycodone - a morphine-like drug - has almost quadrupled in the Netherlands. More than a million Dutch people are prescribed the painkiller annually, especially after a major surgery. Ten percent of patients are at risk of addiction.
In the past, patients would stay in the hospital for weeks, where healthcare staff kept a close eye on their medication intake. Now, patients go home after one or two days. Kleinlugtenbelt: "To put it bluntly: you are given a bag with pills and instructions, and then you have to figure it out for yourself. That doesn’t always work out well."
We’re seeing two groups emerge: people who become addicted and go "shopping around" at different doctors to get more pills. And people who are afraid of the medication and don’t take it, even though they need it for a proper recovery. Kleinlugtenbelt: "Then they come back to the outpatient clinic after six weeks and can’t move their knee. Then you have a real problem, and it is too late to fix it."
The idea on the Wadden Sea led to a collaboration between Deventer Hospital, the University of Twente (TechMed Centre), and Saxion University of Applied Sciences. The goal: to develop an intelligent medication dispenser. Not one that dispenses a tablet at fixed times, but a system that accurately records how much a person uses, automatically reduces the medication according to a protocol, and immediately informs the doctor if usage is irregular.
How does the PainSafe differ from a regular pillbox? Kleinlugtenbelt: "This dispenser has a built-in algorithm based on the hospital’s pain protocol. The patient enters a pain score, and the box never dispenses more than the patient needs and automatically reduces the dosage when necessary. A key advantage: the patient can’t access it easily. The pills only come out of the device when the algorithm allows it.
If someone requests another dose too soon, instead of dispensing, an instruction is given, for example, to take paracetamol first. "Or a message is displayed telling you to contact the hospital within 24 hours." Then we look at whether this is a potential addiction or a complication," said Kleinlugtenbelt.
For senior research coordinator Dr Ellie Landman, the data aspect is particularly interesting. Every action generates data: pain scores entered, times requested, dispensed/not dispensed, and notifications. "We normally don’t have that information. During a parallel study, we asked people to keep track of their intake for two weeks. But that data turned out to be unreliable. The very people we need this information from - those who use a lot - don’t complete the form correctly."
This objective data makes it possible to truly improve pain management. Landman: "We can now see: is the protocol working as intended? Where is the bottleneck? When do people request extra medication?" It’s information that simply didn’t exist before.
The potential gains are enormous. PainSafe delivers the right amount of pain relief at the right time, without the risk of overuse or underuse. Patients no longer have to keep track of when they are allowed to take what pill. Recovery is better because pain remains well-controlled. This increases their mobility, which ultimately leads to fewer patients requiring long-term care.
There is also less risk of opioid addiction, and a fourth advantage is less medication waste in the environment. Kleinlugtenbelt: "If you see how many fewer tablets are used with PainSafe compared to what is currently sold over the counter, the difference is significant. Because not all dispensed medicine is used, a large portion is flushed down the toilet or ends up in the trash. Ultimately, all medication returned from the pain box should be reusable."
In 2022, the team was awarded a Pioneers in Health Care voucher. This enabled them to get started in earnest for the first time. "We were able to hire a junior researcher who delved into the laws and regulations, investigated what patients want, and translated the existing pain protocol into an algorithm. At the University of Twente, it became practical: how should the tablets be placed in the box? How do they come out? Ultimately, we linked the algorithm and the device, and it became a working prototype," says Kleinlugtenbelt.
Another notable aspect was the patient study conducted by a Saxion intern. A striking finding: while researchers were concerned about data protection, patients actually wanted their data to be shared with their doctor. "People felt it was important for their doctor to be able to see how they were using their medication," says Landman.
With the prototype in hand, the team is at a turning point. "The most difficult issue now is funding," says Kleinlugtenbelt. "To further develop the pain box into a market-ready product, two PhD students are needed: one for the clinical side and one for the technical side. The necessary funding for these researchers isn’t yet available. There is interest from a company that wants to produce the device. But they say: it has to be developed first; there has to be an improved prototype that we can start manufacturing"
The team’s vision is clear. Kleinlugtenbelt: "Ideally, opiates would only be provided at home via a controlled box like this-not as a form of coercion, but as a means of safety and security. Realistic? Maybe not for everyone, but certainly for a large group of orthopaedic patients."
The first step has been taken: from idea to prototype. The next step - from prototype to practice - will take some time, but the team remains confident. Because, as Kleinlugtenbelt puts it: "It would be a shame to let this opportunity pass."
The Pioneers in Health Care (PIHC) Innovation Fund is a collaboration between the University of Twente (TechMed Centre), Saxion University of Applied Sciences, and the hospitals MST, ZGT, and Deventer Hospital. Each year, the Fund provides ¤600,000 for 10 innovative projects that make smart use of technology for the healthcare of tomorrow. PIHC brings doctors and researchers together to develop new technology for better patient care or to use existing technology for new medical applications.
Smart medication box to improve the use of pain medication at home
