Using ecological momentary assessment to evaluate neuropathic pain experienced by adults with SCI: recommendations and participant perceptions

Abstract

Purpose

Neuropathic pain is a debilitating consequence of spinal cord injury. Ecological momentary assessment can be a valuable research tool for understanding temporal fluctuations in neuropathic pain and designing effective management strategies. The objectives of this study were to (a) describe strategies necessary to adapt ecological momentary assessment to measure neuropathic pain in adults with spinal cord injury, and (b) explore participant perceptions of using ecological momentary assessment to measure pain sensations.

Methods

End-users with spinal cord injury provided input to guide development of an ecological momentary assessment protocol. Six adults with spinal cord injury (ages 27–50 years, M = 39.33 ± 8.24) engaged in the six-day protocol and completed six daily neuropathic pain assessments. Upon finishing participants completed a semi-structured interview regarding their protocol experiences. A qualitative content analysis was used to analyze the interview data.

Results

Participants reported that this specific ecological momentary assessment protocol was unobtrusive to their daily routines, and effectively captured their neuropathic pain sensations. However, participants experienced increased neuropathic pain due to the repeated nature of assessments.

Conclusion

Ecological momentary assessment can capture the dynamic nature of neuropathic pain experienced by persons with spinal cord injury. However, caution should be taken when designing intensive pain-related protocols to minimize pain exacerbation.

IMPLICATIONS FOR REHABILITATION

• Neuropathic pain affects up to 75% of people with spinal cord injury and is one of the most frequently occurring, debilitating forms of pain.

• Appropriate and feasible pain data collection methods are necessary to acquire a better understanding of how neuropathic pain manifests in people with spinal cord injury.

• Implementing ecological momentary assessment in a rehabilitation setting may help facilitate the monitoring of neuropathic pain for both rehabilitation professionals and persons with SCI.

• Using ecological momentary assessment may lead to a better understanding of individual temporal patterns of neuropathic pain that could inform the design of tailored neuropathic pain management techniques.

Keywords:

• Ecological momentary assessment
• neuropathic pain
• spinal cord injury
• naturalistic assessment
• protocol design

Ethical approval

UBC Behavioural Research Ethics Board approved this study protocol, and participants provided written informed consent prior to enrolling in the study.

Disclosure statement

All authors contributed substantially to the conception and design of this study, in addition to drafting or critically revising the article. The final version of this article has been approved by all authors. One author, RS, was also a participant in the study. RS’s experience and expertise in the design and analysis of qualitative studies was critically important. RS was blinded to the identity of the participants during analysis, and all coded transcripts were reviewed by the first author. This strategy reduced the likelihood that his participation led to bias during data analysis. All authors declare that there is no financial interest or benefit that has arisen from the direct applications of our research.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.