Ecological Momentary Assessment Methodology in Chronic Pain Research: A Systematic Review

Abstract

Self-reported pain intensity assessments are central to chronic pain research. Ecological momentary assessment (EMA) methodologies are uniquely positioned to collect these data, and are indeed being used in the field. However, EMA protocols are complex, and many decisions are necessary in the design of EMA research studies. A systematic literature review identified 105 articles drawing from 62 quantitative EMA research projects examining pain intensity in adult chronic pain patients. Study characteristics were tabulated to summarize and describe the use of EMA, with an emphasis placed on various dimensions of decision-making involved in executing EMA methodologies. Most identified studies considered within-person relationships between pain and other variables, and a few examined interventions on chronic pain. There was a trend toward the use of smartphones as EMA data collection devices more recently, and completion rates were not reported in nearly one third of studies. Pain intensity items varied widely with respect to number of scale points, anchor labels, and length of reporting period; most used numeric rating scales. Recommendations are provided for reporting to improve reproducibility, comparability, and interpretation of results, and for opportunities to clarify the importance of design decisions.

Perspective: Studies that use EMA methodologies to assess pain intensity are heterogeneous. Aspects of protocol design, including data input modality and pain item construction, have the potential to influence the data collected. Thorough reporting on design features and completion rates therefore facilitates reproducibility, comparability, and interpretation of study results.

Keywords: Ecological momentary assessment; chronic pain; electronic diaries; experience sampling; self-report.

Copyright © 2018 The American Pain Society. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1

PRISMA flowchart describing the identification of articles

Fig. 2

Number of studies (n = 105) by publication year

Fig. 3

Distribution of data input modalities by decade of publication

Fig. 4

Characteristics of momentary response scales NR=Not reported

Fig. 5

Funnel plot of mean EMA completion rates Studies applying a threshold for minimally acceptable completion before calculation of completion rates are shown as squares, paper diaries are shown as diamonds