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Temporal dynamics of pain

an application of regime-switching models to ecological momentary assessments in patients with rheumatic diseases

Schneider, Stefana,*; Junghaenel, Doerte U.a; Ono, Masakatsua; Stone, Arthur A.a,b

doi: 10.1097/j.pain.0000000000001215
Research Paper
Editor's Choice

Advances in pain measurement using ecological momentary assessments offer novel opportunities for understanding the temporal dynamics of pain. This study examined whether regime-switching models, which capture processes characterized by recurrent shifts between different states, provide clinically relevant information for characterizing individuals based on their temporal pain patterns. Patients with rheumatic diseases (N = 116) provided 7 to 8 momentary pain ratings per day for 2 weekly periods, separated by 3 months. Regime-switching models extracted measures of Average pain (mean level over time), Amplitude (magnitude of shifts in pain levels), Persistence (average duration of pain states), and Dominance (relative duration of higher vs lower pain states) for each patient and assessment period. After controlling for Average pain, the Persistence of pain states uniquely predicted emotional functioning measures, whereas the Dominance of higher pain uniquely predicted physical functioning and pain interference. Longitudinal analyses of changes over the 3 months largely replicated cross-sectional results. Furthermore, patients' retrospective judgments of their pain were uniquely predicted by Amplitude and Dominance of higher pain states, and global impressions of change over the 3 months were predicted by changes on Dominance, controlling for Average pain levels. The results suggest that regime-switching models can usefully capture temporal dynamics of pain and can contribute to an improved measurement of patients' pain intensity.

Regime-switching models applied to momentary pain intensity assessments can enhance the measurement of clinically meaningful temporal characteristics of pain.

aDornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, USA

bDepartment of Psychology, University of Southern California, Los Angeles, CA, USA

Corresponding author. Address: Dornsife Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA 90089-3332, USA. Tel.: 213-821-1774; fax: 213-821-2716. E-mail address: (S. Schneider).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received October 20, 2017

Received in revised form February 13, 2018

Accepted February 28, 2018

© 2018 International Association for the Study of Pain
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