Rethinking measurement of movement-evoked pain with digital technology

Movement-evoked pain (MEP) may be a useful metric for phenotyping musculoskeletal pain conditions. However, there is significant disagreement over operationalization, and no studies have assessed stability of MEP over time. Fitbit and Ecological Momentary Assessment (EMA) data were collected from adults with moderate-to-severe chronic pain schedule to receive lumbar/thoracolumbar fusion surgery (N=114). On average, participants provided 323 h of Fitbit data and 74 EMA surveys (84% completion rate). To mimic task-based assessment of MEP using the 6-minute walk test, EMA pain ratings completed within 3 h of walking at a speed ≥70spm for at least 6 min were extracted. Of the full sample, 91 individuals (80%) had any instances of pain ratings following 6-minute activity bouts (Median=6, SD=11). Post-activity pain scores exhibited good within-person consistency (ICC=.76). However, between-person differences in average pain accounted for >70% of the variance in post-activity pain. MEP change scores defined as the difference between post-activity and pre-activity pain scores had poor reliability (ICC =.08). MEP change scores were not associated with average pain or factors related to the uncontrolled nature of digital assessment (e.g., activity amount, time from activity to pain report). However, MEP change scores tended to be lower when the preceding pain rating was elevated (β = -7.96, 95% Credible Interval: -9.28, -6.66), suggesting ceiling effects. Small effects of time of day and prior activity were also observed, which could contaminate MEP assessed in the lab or clinic. Continued development of digital methodologies for assessing MEP is recommended. PERSPECTIVE: Existing movement-evoked pain assessments have limitations. Post-activity pain ratings capture overall disability and day-to-day fluctuations in pain, rather than the relationship between movement and pain. Pre-to-post activity change scores had poor reliability when assessed naturalistically and over time. Digital methodologies capture movement-evoked pain continuously across time, contexts, and real-world environments.