Background & Aims

There is an assumption that persons with chronic pain perceive their condition as having improved or worsened solely based on intensity of their pain. However, there is reason to believe that patients’ dispositional characteristics as well as day-to-day fluctuations in other symptoms (e.g., sleep problems, negative affect), might also influence patients’ perceptions about their overall condition. Longitudinal study designs using daily electronic diaries are known to be superior for the assessment of rapidly fluctuating symptoms in people with chronic pain.1 The aim of this study was to examine the degree to which day-to-day fluctuations in pain intensity, sleep quality, and negative affect contributed to patients’ perceptions of improvement. We also examined if the impact of daily fluctuations in sleep, negative affect, and pain intensity on patients’ perceived improvement varied as a function of sociodemographic factors or dispositional factors such as catastrophic thinking.

Methods

Patients with chronic pain (N = 334) were recruited to enter daily assessments on a smartphone pain app (MobileNetrix for iPhone and Android) as part of previous clinical trials.3 Eligible participants signed a consent form and completed sociodemographic information and baseline questionnaires including the Pain Catastrophizing Questionnaire.4 All participants were asked to complete a 5-item daily assessment on the pain app. The assessment consisted of ratings of sleep disturbances, negative affect (i.e., anxiety & depressive symptoms), and pain intensity on visual analogue scales (VAS, 0-10). Every day patients were also asked to report whether their overall condition had worsened, remained the same, or gotten better over the past 24 hours (“Over the past 24 hours how much have things changed?” 0=better; 5=same; and 10=worse). We conducted cross-lagged analyses to help determine predictors of perceived improvement.

Results

Three hundred thirty-four (N=334) subjects with chronic pain successfully downloaded the pain app and entered daily assessments for up to 30 days. They averaged 53.5±14.4 years of age, 12.8±11.8 years pain duration, 29.6±7.4 BMI, and the majority were White (83.3%), female (75.8%), and with lower back pain (40.4%). Results from a series of multilevel analyses indicated that day-to-day increases in sleep problems, negative affect, and pain intensity were associated with lower ratings of condition improvement (all p’s < 0.01). None of the demographic characteristics influenced patients’ reports of condition improvement, but dispositional catastrophizing was associated with lower average ratings of condition improvement across the 30-days (p < 0.001). Results from a multilevel moderation analysis indicated that day-to-day increases in pain intensity were associated with perceived condition worsening, but this association was strongest among those with higher levels of catastrophizing.

Conclusions

There has been an increased use of smartphone pain applications (apps) with daily monitoring among persons with chronic pain. Frequent daily assessments of pain and perceived improvement can help to identify those who are prone to report extreme changes in perceived improvement or worsening of their pain over time. The results of this study suggest that changes in perceived condition worsening are related to multiple factors including pain intensity, activity interference, sleep disturbances and fluctuations in mood. Most importantly, those who showed higher ratings on pain catastrophizing tended to perceive that their condition was much worse than the ratings would indicate, particularly around times when they experienced a flare-up of their pain.

References

1. May M, Junghaenel DU, Ono M, Stone AA, Schneider S.J Ecological Momentary Assessment Methodology in Chronic Pain Research: A Systematic Review. Pain. 2018 Jul;19(7):699-716.
2. Jamison RN, Xu X, Wan L, Edwards RR, Ross EL. Determining pain catastrophizing from daily pain app assessment data: role of computer-based classification. J Pain. 2019;20:278-287.
3. Ross EL, Jamison RN, Nicholls L, Perry BM, Nolen KD. Clinical integration of a smartphone pain app for patients with chronic pain: retrospective analysis of predictors of benefits and patient engagement between clinic visits. J Med Internet Res. 2020;22:e16939.
4. Sullivan MJL, Bishop SR, Pivik J: The Pain Catastrophizing Scale: Development and validation. Psychol Assess. 1995;7:524-532

Presenting Author

Robert N. Jamson

Poster Authors

Robert Jamison

PhD

Brigham & Womens Hospital

Lead Author

E-mail

Jiaqi Bi

BSc

Western University, London, Canada

Lead Author

E-mail

SAMANTHA MEINTS

PhD

Dept. of Anesthesiology, Perioperative & Pain Medicine, Brigham & Women’s Hospital, Boston, MA, USA

Lead Author

E-mail

Robert Edwards

PhD

Brigham & Women's Hospital/Harvard Medical School

Lead Author

E-mail

Marc O Martel

PhD

McGill University

Lead Author

E-mail

Topics

  • Assessment and Diagnosis

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