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

Stone, Arthur A.; Broderick, Joan E.; Goldman, Roberta E.; Junghaenel, Doerte U.; Bolton, Alicia; May, Marcella; Schneider, Stefan

doi:10.1016/j.jpain.2020.08.003

Cited by 20 publications

(24 citation statements)

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“…Another limitation is that we captured only peak pain intensity per headache episode for EM and per headache day for CM. Assessing least intense and most intense pain, average pain or multiple time points using ecological momentary assessment approaches may provide a more robust measure of the effects of treatment on pain (19–21). We did not assess the benefits of erenumab on the intensity of migraine features other than pain, including associated symptoms and functional status during the prodrome, headache phase, and post-drome.…”

Section: Discussionmentioning

confidence: 99%

Reduction in migraine pain intensity in patients treated with erenumab: A post hoc analysis of two pivotal randomized studies

et al. 2021

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Background Erenumab (erenumab-aooe in the US) effectively reduces monthly migraine days in episodic and chronic migraine. This traditional outcome does not capture the intensity of headache pain on days with migraine. Methods This post hoc analysis of two pivotal randomized, placebo-controlled studies in patients with episodic migraine and chronic migraine examined the effect of erenumab 70 and 140 mg on migraine pain. Cumulative monthly migraine pain intensity is the sum of the peak pain intensity scores (0 = no migraine to 3 = migraine day with severe pain) on migraine days. Change from baseline in cumulative monthly migraine pain and average monthly pain intensity was assessed over months 4 to 6 for episodic migraine and month 3 for chronic migraine; change in average monthly pain intensity was assessed among monthly migraine days responders/non-responders. Results Efficacy analysis included 946 patients for the episodic migraine study and 656 patients for the chronic migraine study. Cumulative monthly migraine pain decreased significantly with erenumab versus placebo ( p < 0.001, for episodic migraine and chronic migraine). In addition, monthly average migraine pain intensity decreased significantly with erenumab versus placebo for episodic migraine ( p < 0.01); decreases were non-significant for chronic migraine. In comparison with placebo-treated patients, a greater proportion of erenumab-treated patients were pain intensity responders regardless of threshold used. Episodic migraine and chronic migraine patients with a ≥50% reduction in monthly migraine days (responders) had a greater reduction in monthly average pain intensity than non-responders. Conclusions Erenumab reduced cumulative monthly migraine pain in episodic migraine and chronic migraine patients and significantly reduced monthly average migraine pain in episodic migraine, demonstrating treatment benefit beyond reduction in migraine frequency. Clinical Trial Registration: ClinicalTrials.gov, NCT02456740; ClinicalTrials.gov, NCT02066415

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Section: Discussionmentioning

confidence: 99%

Reduction in migraine pain intensity in patients treated with erenumab: A post hoc analysis of two pivotal randomized studies

et al. 2021

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“…Pain intensity variability in the present study was broadly similar over the course of a week. A recent study showed that various pain indices are perceived as having most impact on one's experience; individuals living with chronic pain consider their worst pain and more time in high intensity pain as most meaningful whereas clinicians give more weight only to worst pain intensity scores 71 . This has important implications not only for clinical care but also for research.…”

Section: Intra-and Inter-individual Pain Intensity Variabilitymentioning

confidence: 99%

“…In recent years, intra-individual variability has been identified as an important aspect to study and understand, as opposed to conceptualizing it as noise 49 . There is a growing body of literature focusing on pain intensity variability in acute LBP 8,77 , CLBP 11,40,44 , and other adult 1, 2, 5-7, 16, 22, 31, 38, 42, 56, 58, 59, 67, 73, 78-80, 89, 90 and pediatric 27,81 populations experiencing chronic pain (see 66,68,71 for an overview). Increased pain intensity variability has been shown to be positively associated with pain recall bias 73 .…”

Section: Introductionmentioning

confidence: 99%

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An Ecological Momentary Assessment Study of Pain Intensity Variability: Ascertaining Extent, Predictors, and Associations With Quality of Life, Interference and Health Care Utilization Among Individuals Living With Chronic Low Back Pain

Pagé

Gauvin

Sylvestre

et al. 2022

The Journal of Pain

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Over the past decades, real-time data collection methods involving Experience Sampling or Ecological Momentary Assessment (EMA) have received increasing attention in pain research. Using EMA, patients rate their momentary pain intensity multiple times per day in their natural environment, which makes it possible to capture temporal features of patients' pain intensity in great detail (7)(8)(9)(10). While assessments of specific aspects of pain intensity other than average pain are beginning to be acknowledged in research on chronic pain, to date, it is unclear which temporal indices of patients' pain intensity should be assessed to achieve the greatest utility.…”

Section: Introductionmentioning

confidence: 99%

Beyond Average: Providers' Assessments of Indices for Measuring Pain Intensity in Patients With Chronic Pain

et al. 2021

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Introduction: Effective clinical care for chronic pain requires accurate, comprehensive, meaningful pain assessment. This study investigated healthcare providers' perspectives on seven pain measurement indices for capturing pain intensity.Methods: Semi-structured telephone interviews were conducted with a purposeful sample from four US regions of 20 healthcare providers who treat patients with chronic pain. The qualitative interview guide included open-ended questions to address perspectives on pain measurement, and included quantitative ratings of the importance of seven indices [average pain, worst pain, least pain, time in no/low pain, time in high pain, fluctuating pain, unpredictable pain]. Qualitative interview data were read, coded and analyzed for themes and final interpretation. Standard quantitative methods were used to analyze index importance ratings.Results: Despite concerns regarding 10-point visual analog and numeric rating scales, almost all providers used them. Providers most commonly asked about average pain, although they expressed misgivings about patient reporting and the index's informational value. Some supplemented average with worst and least pain, and most believed pain intensity is best understood within the context of patient functioning. Worst pain received the highest mean importance rating (7.60), average pain the second lowest rating (5.65), and unpredictable pain the lowest rating (5.20).Discussion: Assessing average pain intensity obviates obtaining clinical insight into daily contextual factors relating to pain and functioning. Pain index use, together with timing, functionality and disability, may be most effective for understanding the meaning to patients of high pain, how pain affects their life, how life affects their pain, and how pain changes and responds to treatment.

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

Cited by 20 publications

References 55 publications

Reduction in migraine pain intensity in patients treated with erenumab: A post hoc analysis of two pivotal randomized studies

Reduction in migraine pain intensity in patients treated with erenumab: A post hoc analysis of two pivotal randomized studies

An Ecological Momentary Assessment Study of Pain Intensity Variability: Ascertaining Extent, Predictors, and Associations With Quality of Life, Interference and Health Care Utilization Among Individuals Living With Chronic Low Back Pain

Beyond Average: Providers' Assessments of Indices for Measuring Pain Intensity in Patients With Chronic Pain

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