Pain Squad

Pain Squad

Events, Seasonal and Short-Term (GOLD)

Client Credits: Hospital for Sick Children
Jennifer Stinson – Scientist, The Hospital for Sick Children
Carol Chan – Clinical Research Project Coordinator
Cynthia Nguyen – Clinical Research Assistant
Navreet Gill – Clinical Research Project Coordinator
Lindsay Jibb – Doctoral Student

Agency Credits: Cundari
Mike Orr – Account Manager, User Experience, Information Architect
Cory Eisentraut – Associate Creative Director, Copywriter
Mike Sipley – Associate Creative Director, Art Director
Stuart Thom – Interactive Designer
Carol-Ann Granatstein – Producer; Director, Marketing and Communications
Kawal Singh – Account Manager, Videographer
Wayne Gomes – Chief Technology Officer
Brent Choi – Chief Creative Officer
Cherie O’Connor – Producer
Rob Dutchin – Videographer
Patrick Lee – Developer
Jin Kim – Developer
Ali Asim – Developer
Paul Skinner – Editor (Stealing Time)
Ed Zych – Sound Design

Crossover Notes:
All winning cases contain lessons that cross over from one case to another. David Rutherford has been identifying these as Crossover Notes since CASSIES 1997. The full set for CASSIES 2013 can be downloaded from the Case Library section at

Crossover Note 3. Core Equity versus Price & Promotion
Crossover Note 5. The Total Brand Experience
Crossover Note 6. Should the product be improved?
Crossover Note 22. Humour in a Serious Category

To see creative, click on the links that are embedded in the case.


Business Results Period (Consecutive Months): March 2012 -July 2012
Start of Advertising/Communication Effort: March 26, 2012
Base Period as a Benchmark: Calendar 2006

a) Overall Assessment

Every year at Toronto’s Hospital for Sick Children, they are treating hundreds of children with cancer. One of the worst parts of what these young patients have to go through is pain. To combat it, doctors, nurses and researchers are continually working on innovative ways to manage and minimize the pain experienced during treatment. One way to track cancer pain is to ask patients to record exactly how they are feeling in a paper pain diary. After treatment, however, many patients are too tired or discouraged to keep detailed reports that are required to help clinicians better understand and treat their pain.

Previously, this information was recorded using a handwritten pain diary by patients with persistent pain. However, this was highly ineffective as most people complete the diary just before they were scheduled to come back to see their health care provider leading to inaccurate records. One study showed only 11% of pain diary entries were completed on time. Sustained on-time compliance (patients completing the diary every day) is critical to managing care. With 80% being the generally accepted bar for good compliance, a new solution was needed.[Crossover Note 6]

Recently, an electronic pain diary (eOuch) was developed for the Palm Tungsten PDA. The diary was portable and used alarms to remind patients to complete the survey. The study also employed a standard technique of offering nominal monetary incentives ($10-$20) to help encourage compliance. [Crossover Note 3] 

The diary dramatically improved accuracy. There was a marked improvement in compliance in the first week at 88% but this quickly dropped to 73% in week 2 as enthusiasm faded.

Overall the study was effective but compliance, sustainability and scalability of the incentives remained challenges to larger scale research and patient self-management.

b) Resulting Business Objectives

There were 3 business objectives:

1) Compliance: surpass 80% compliance in both weeks of the study and ensure accurate data is collected at the correct time, twice a day. 

The key is keeping the kids engaged and complying past the first week.

2) Sustainability: reduce or eliminate monetary incentives and enhance internal motivation to enable the app to evolve beyond a research project and become a functional tool in patient self-management.

3) Awareness: generate interest in the medical community and general public to deploy the app in further studies and support for the application.

c) Annual Media Budget
$100,000 – $200,000

d) Geographic Area
Hospital for Sick Children, Toronto

a) Analysis and Insight

The research team spent a lot of time with the young patients. 

While this gave the team a sobering reality of their life, it allowed us to talk to them, and more importantly, get to know them not as patients, but as people. This is what brought us to our insight.

KEY INSIGHT: Children with cancer, are still children.

They love to have fun, play, And because they may not get as much time to have fun as other children, they cherish it even more.

In addition, like every child, they don’t always do what you tell them to.

INSIGHT #2: Children want to help but can feel helpless.

When children are diagnosed, they feel a loss of control in their lives. Their care is governed by experts and treatment schedules. The application gave kids an opportunity take control of their care. By recording their experience they took responsibility for managing their pain.

It is also gave them an opportunity to help. It was important to make the connection for patients that the data contributed by completing the surveys would help other kids facing similar situations. Connecting the simple act of keeping a diary to something greater was powerfully motivating.

In the end, we needed to find a way to motivate the children to comply but have fun doing it (not making it a chore or task). And not just in week one, but in the second week as well (as noted earlier, previous data collection methods dropped dramatically in week 2). 

And with the business objective of sustainability, this could not be accomplished through any gifts or monetary rewards.

b) Communication Strategy

The communication strategy was anchored by the The Pain Squad theme. The theme was designed to accomplish a number of strategic intents. [Crossover Note 5] It was a squad which meant you weren’t in it alone, there was an implied community. The squad was formed to fight pain which externalized pain and gave license to combat it without fighting yourself. In the narrative, the squad’s fight against pain was portrayed as an epic struggle that would benefit others suffering from pain. Finally the case structure gave a purposeful meaning to completing each survey – it wasn’t just a bunch of questions about your pain but an exercise in collecting clues to make the case against pain (helping the kids and their health care team to better understand it and treat it).

The application design employed gaming mechanics to further reinforce the theme and motivate behaviour. Periodic reward systems advanced the narrative and gave inconsistent users a reason to come back. Goal-based reward systems (streaks, compliance) encouraged more compliant users to never miss a survey.

a)Media Used

The only ‘media’ used was the iPhone that each patient was given. iPhone was selected because it combined platform stability and hardware performance that would assure a high reliability application. Android was emerging but unstable and the hardware was nowhere near the same quality and reliability.

b)Creative Discussion

To begin, each patient was given an iPhone loaded with the Pain Squad App. Then, twice a day they received an alert informing them it was time to complete their pain report. The app, designed to feel like a video game, had all the police clichés like a dark office and a steaming cup of coffee on the old-school desk. Each pain report was stylized to look just like a detective’s notepad. Diagrams of the body looked like they were sketched into the pad and after each question was completed the pages flipped over the wire spirals. Each of these stylistic choices was made to keep the patients engaged and entertained.

Additionally, the reports were designed to be very easy to navigate and were completely intuitive to Apple’s native functionality. With a simple flick of the finger, kids could easily identify exactly where on their body it hurt and how bad the pain was. But making the reports easy to fill out was the easy part. Our real challenge was ensuring that our patients completed two reports a day, every day. To do this, we built in a fun, graduation structure. After completing 3 reports in a row, recruits received a message from the Chief informing them that they were moving up the ranks.

Of course these messages weren’t simple text messages, they were videos featuring the casts of Canada’s top police dramas, Flashpoint and Rookie Blue. We created dozens of these motivational videos that then popped-up throughout the Pain Squad mission. Then, once a child completed their last pain report, they were sent one final video informing them that they were being retired from the field.

c)Media Discussion


a) Sales/Share Results

The results averaged over 91% compliance through the feasibility study with the young patients. A remarkable result in pediatric healthcare.

More importantly, while compliance in week 1 was 86% (far exceeding the 80% bar) it actually increased in week 2 to 95% (a 30% increase over the eOuch). 

On the objective of sustainability, three other Canadian hospitals are currently rolling out the initiative and commercial development is underway. 

With sights on commercial distribution of the app, the success of Pain Squad has caught the attention of the world. 

To date, the app has been featured in Mashable, Fast Company, Globe & Mail, Toronto Star, Global news, and hundreds of other publications.

Pain Squad was awarded a Gold Cannes Lion for usability, as well as another Gold Lion for creative excellence in mobile healthcare. The creative acclaim also includes a Gold Clio, Best in Show at the Marketing Awards as well as another Gold M, and dozens of other accolades in Canada and around the world. 

The result of the PR has led to several international healthcare inquries to the Toronto Sick Kids in hopes to use or learn from the app.

b) Consumption/ Usage Results

c) Other Pertinent Results

d) Return on Investment

a)General Discussion

Digging deeper into the data, a post-study survey assessed key usability features of the eOuch and Pain Squad diaries. Patients were surveyed on difficulty of use and interference in the their day and the results were the same for both the eOuch and Pain Squad – 0%. In other words, Pain Squad was not easier, nor less intrusive than the eOuch.

Furthermore, both systems had ‘alarms’ to signal the patient to comply and both systems were equally portable to be with the patient at all times.

The only difference to attribute the increased compliance to was the infusion of a creative idea that persuaded the patient to comply and be vested into the experience over the two week period.

b)Excluding Other Factors
Spending Levels:

There were zero monetary incentives to produce these results.



Distribution Changes:


Unusual Promotional Activity:


Other Potential Causes: