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 to our knowledge have assessed stability of MEP over time. We collected Fitbit and Ecological Momentary Assessment (EMA) data from adults with moderate-to-severe chronic pain schedule to receive lumbar/thoracolumbar fusion surgery (N=114). On average, participants provided 323 hours of Fitbit data and 74 EMA surveys (84% completion rate). To mimic task-based assessment of MEP using the 6-minute walk test, we extracted EMA pain ratings completed within 3 hours of walking at a speed ≥67spm for at least 6 minutes. Of the full sample, 93 individuals (82%) had any instances of pain ratings following 6-minute activity bouts (Median=7, SD=11). Post-activity pain scores exhibited good within-person consistency (ICC = .75). 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 lag-1 pain was elevated (β = -8.49, p < .001), suggesting ceiling effects. We also observed small effects of time of day and prior activity, which could contaminate MEP assessed in the lab or clinic. We recommend the continued development of digital methodologies for assessing MEP.