I. Indices of Pain Intensity Derived From Ecological Momentary Assessments: Rationale and Stakeholder Preferences

Area of Science:

• Pain research
• Clinical outcomes assessment
• Patient-reported outcomes

Background:

• Traditional chronic pain assessment relies on average pain intensity.
• This overlooks crucial temporal pain characteristics like variability and maxima.
• Ecological momentary assessment (EMA) offers a method to capture these temporal aspects.

Purpose of the Study:

• To explore the rationale for using additional pain indices beyond average intensity.
• To identify which temporal pain measures are most valued by patients, clinicians, and clinical trialists.
• To inform the development of more comprehensive pain assessment strategies.

Main Methods:

• Interviews were conducted with patients (n=32), clinicians (n=20), and clinical trialists (n=20).
• Participants ranked their preferences for various pain indices, including Average, Worst, and Least Pain, Time in High Pain, Time in No/Low Pain, Pain Variability, and Pain Unpredictability.
• Preference hierarchies were analyzed for each stakeholder group.

Main Results:

• Distinct preference hierarchies for pain indices were observed across stakeholder groups.
• Patients prioritized Worst Pain and Time in High Pain, followed by Pain Variability and Unpredictability.
• Clinical trialists favored Average Pain, while clinicians favored Worst Pain.

Conclusions:

• Multiple temporal aspects of pain are important to diverse stakeholders in chronic pain research and management.
• Current pain assessment may be enhanced by incorporating measures of pain variability, unpredictability, and extreme pain experiences.
• Considering these varied stakeholder preferences can lead to more holistic and effective evaluation of pain management interventions.