Ecological Momentary Assessments of Daily Pain Experiences in Bothersome and High‐Impact Chronic Pain

BACKGROUND: High-impact chronic pain (HICP), defined as persistent pain substantially limiting daily activities, affects millions of adults and poses a public health challenge. However, as prior knowledge comes largely from retrospective self-report measures, little is known about how HICP manifests in daily life. METHODS: This study used the comprehensive Ecological Momentary Assessment of pain (cEMAp) instrument to assess pain-related experiences four times daily over 7 days in individuals with chronic musculoskeletal pain. Using the Graded Chronic Pain Scale-Revised, we compared individuals with HICP (n = 66) with bothersome chronic pain (n = 41), a group with similar pain frequency but less interference with daily activities. Each prompt assessed pain intensity, interference, cognitions, behaviours, coping strategies, and pain characteristics over the preceding 2 h. RESULTS: Both groups reported similar pain intensity levels, but the HICP group reported more frequent interference with physical, mental, and social activities. No group differences emerged in daily mood or negative pain-related cognitions. Exploratory analyses suggested that many daily experiences were similar across groups, with differences observed in selected pain qualities, coping strategies, and pain behaviours. Analyses of response distributions showed some similarity across groups in many experiences. CONCLUSIONS: The most consistent distinction between the groups was interference frequency, consistent with the operationalization of HICP as pain that disrupts daily functioning, while several other pain-related experiences were similar across groups. cEMAp data complement traditional retrospective assessment by providing a more detailed view of biopsychosocial aspects of chronic pain in everyday life. SIGNIFICANCE STATEMENT: Prior understanding of high-impact chronic pain (HICP) has largely relied on retrospective measures. Using the comprehensive Ecological Momentary Assessment of pain (cEMAp) instrument, we found that HICP was distinguished primarily by more frequent interference with daily activities rather than greater pain intensity. Our findings also reveal similarities and differences across other pain-related experiences, highlighting the value of multidimensional real-world assessment beyond pain intensity alone.