Comparison of musculoskeletal pain severity and pain interference using ecological momentary assessment: a longitudinal analysis

Abstract

Musculoskeletal (MSK) pain can be assessed in terms of its intensity and by how it interferes with daily activities. This study examined whether: 1) MSK pain intensity is associated with pain interference, and 2) demographic and psychological factors explain variability in pain interference. We recruited adult patients who presented to the emergency department (ED) of a single academic medical center with a chief complaint of MSK pain of one-week duration or less; subjects completed a baseline survey in the ED, and using a mobile health application, they completed longitudinal assessments regarding pain catastrophizing (via the Pain Catastrophizing Scale), pain severity (via the Brief Pain Inventory) and pain interference (via the 6-item Patient-Reported Outcomes Measurement Information System) on 15 different days throughout 1-month post-ED discharge. We used a random effects model to examine the association between the pain severity and interference, accounting for time. We enrolled 52 subjects, 45 (78% female; 34 ± 12 years of age) of whom provided sufficient data for inclusion in the analysis. The average response rate per subject was 73%. Pain severity score decreased from a mean (SD) of 5.8 (2.6) to 3.2 (3.4), and pain interference decreased from an average of 22 (6.6) to 14 (8.2), from day 1 to day 30 post-ED discharge. Pain severity and interference were significantly higher in patients with lower level of education, unemployment, temporary or permanent disability, mental health disorders, excessive rumination, and psychological distress. In the random effects model, pain interference was associated with severity (B=2.6, 95% CI = 2.4-2.8), after accounting for time. These findings suggest that MSK pain severity is associated with interference throughout the first month after ED discharge, and highlight certain subgroups of patients that may be at higher risk of persistent pain severity and interference within 1-month post-ED discharge. Emergency Medicine Foundation & NIH training grant T32HL134615.