Dornsife Center for Self-Report Science, University of Southern California, California.
Dornsife Center for Self-Report Science, University of Southern California, California.
J Pain. 2021 Apr;22(4):371-385. doi: 10.1016/j.jpain.2020.10.002. Epub 2020 Oct 24.
Pain intensity is a complex and dynamic experience. A focus on assessing patients' average pain levels may miss important aspects of pain that impact functioning in daily life. In this second of 3 articles investigating alternative indices of pain intensity derived from Ecological Momentary Assessments (EMA), we examine the indices' associations with physical and psychosocial functioning. EMA data from 10 studies (2,660 patients) were reanalyzed to construct indices of Average Pain, Maximum Pain, Minimum Pain, Pain Variability, Time in High Pain, Time in Low Pain, Pain after Wake-up. Three sets of individual patient data meta-analyses examined 1) the test-retest reliability of the pain indices, 2) their convergent validity in relation to physical functioning, fatigue, depression, mental health, and social functioning, and 3) the incremental validity of alternative indices above Average Pain. Reliabilities approaching or exceeding a level of .7 were observed for all indices, and most correlated significantly with all functioning domains, with small to medium effect sizes. Controlling for Average Pain, Maximum Pain and Pain Variability uniquely predicted all functioning measures, and Time in High Pain predicted physical and social functioning. We suggest that alternative pain indices can provide new perspectives for understanding functioning in chronic pain. PERSPECTIVE: Alternative summary measures of pain intensity derived from EMA have the potential to help better understand patients' pain experience. Utilizing EMA for the assessment of Maximum Pain, Pain Variability, and Time in High Pain may provide an enhanced window into the relationships between pain and patients' physical and psychosocial functioning.
疼痛强度是一种复杂而动态的体验。关注评估患者的平均疼痛水平可能会错过影响日常生活功能的重要疼痛方面。在调查源自生态瞬时评估（EMA）的替代疼痛强度指标的 3 篇文章中的第 2 篇中，我们研究了这些指标与身体和心理社会功能的关系。对来自 10 项研究（2660 名患者）的 EMA 数据进行了重新分析，以构建平均疼痛、最大疼痛、最小疼痛、疼痛变异性、高疼痛时间、低疼痛时间、醒来后疼痛的指标。对三组个体患者数据进行了荟萃分析，检验了 1）疼痛指标的重测信度，2）与身体功能、疲劳、抑郁、心理健康和社会功能的相关性，3）替代指标与平均疼痛的增量有效性。所有指标的可靠性均接近或超过.7，与所有功能领域均显著相关，具有小到中等的效应量。控制平均疼痛后，最大疼痛和疼痛变异性可独特预测所有功能指标，高疼痛时间可预测身体和社会功能。我们认为，替代疼痛指标可以为理解慢性疼痛患者的功能提供新的视角。观点：源自 EMA 的替代疼痛强度汇总指标具有帮助更好地理解患者疼痛体验的潜力。利用 EMA 评估最大疼痛、疼痛变异性和高疼痛时间，可能会更深入地了解疼痛与患者身体和心理社会功能之间的关系。
