Rethinking measurement of movement-evoked pain with digital technology
Madelyn R Frumkin1, Jingwen Zhang2, Ziqi Xu2
1Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, USA; Department of Biomedical Data Science, Dartmouth College, Lebanon, NH, USA.
The Journal of Pain
|December 21, 2025
Summary
Movement-evoked pain (MEP) assessment using digital tools shows promise but needs refinement. While post-activity pain ratings are consistent, change scores lack reliability for tracking pain changes over time in chronic pain patients.
Area of Science:
- Pain research
- Musculoskeletal pain
- Digital health
Background:
- Movement-evoked pain (MEP) is a potential metric for phenotyping musculoskeletal pain.
- Current operationalization of MEP lacks standardization and temporal stability assessment.
- Chronic pain patients often experience significant pain during daily activities.
Purpose of the Study:
- To assess the reliability and validity of digital assessment of movement-evoked pain (MEP) in adults with chronic pain.
- To investigate the stability of MEP metrics over time using wearable sensors and Ecological Momentary Assessment (EMA).
- To explore the relationship between MEP, average pain levels, and digital assessment parameters.
Main Methods:
- Collected Fitbit and EMA data from 114 adults with chronic pain scheduled for spinal fusion surgery.
- Extracted EMA pain ratings within 3 hours of walking at ≥70 steps/min for ≥6 min to mimic task-based MEP.
- Analyzed within-person consistency and between-person variance of post-activity pain scores and reliability of MEP change scores.
Main Results:
- Post-activity pain scores showed good within-person consistency (ICC=.76), but between-person differences explained most variance (>70%).
- MEP change scores (pre- to post-activity pain difference) demonstrated poor reliability (ICC=.08).
- MEP change scores were not associated with average pain or digital assessment factors but were influenced by preceding pain levels (ceiling effects), time of day, and prior activity.
Conclusions:
- Digital assessment of MEP shows potential for continuous, real-world data collection.
- Post-activity pain ratings reflect overall pain and fluctuations, not solely movement-evoked changes.
- MEP change scores derived from naturalistic digital assessments currently lack reliability for clinical use, necessitating further methodological development.
