Tailoring Individualized Evaluation of Pediatric Abdominal Pain Using Ecological Momentary Assessment (EMA)

Abstract

Objective: The current study aimed to determine if it was feasible and acceptable to use ecological momentary assessment to assess individual associations between biopsychosocial contributors to chronic abdominal pain with 2 objective sensors and a mobile application. Specifically, we aimed to determine if it was possible to identify individualized associations between idiopathic pain associations. The goal was to determine if idiographic profiles have clinical value while the field works torward consensus about nomothetic trends. Materials and Methods: Participants included 30 pediatric chronic abdominal pain patients, aged 8 to 17, who wore a physiological monitor and accelerometer that measured sleep and physical activity and answered 4 surveys per day on an app over the course of a 14-day study period. Results: Results indicated that participants were 96.2% and 95.5% compliant to the wrist-worn accelerometer measuring sleep and physical activity, respectively. Participants completed 76.3% of expected surveys and were least adherent to the physiological monitor (37.9%). In addition, it was possible to generate 24 (80%) personalized reports describing unique associations with pain for participants in the study. Discussion: Findings provide initial support for the use of ecological momentary assessment over a 2-week period to inform and create personalized profiles for improved clinical care in this population.

Microtemporal Relationships in the Fear Avoidance Model

“…During recruitment, N = 185 individuals were assessed for eligibility, N = 142 were eligible and approached for the study, N = 79 individuals indicated that they would like to consent and participate in the study, and N = 71 completed the data collection period. The current study was conducted as part of a larger study that examined associations between biopsychosocial factors and abdominal pain [see Cushing et al 9 for more information on the larger study protocol).…”

“…Findings indicated that pediatric pain patients found this protocol to be highly feasible and acceptable. 9 Given the many potential points of intervention for youth with chronic pain, narrowing the field to those points most important to a given patient's pain process may serve to decrease treatment burden and increase adherence to the interventions prescribed. Future interventions could consider a similar baseline data collection period to inform tailored pediatric pain interventions related to Fear Avoidance variables.…”

“…Recent meta-analyses have indicated that not all patients benefit from well-established efficacious pediatric pain interventions 7,8. Identifying microtemporal processes may provide new opportunity to increase the efficacy of current interventions by providing more personalized treatment 9…”

Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review

“…Pediatric abdominal pain has also been evaluated by means of accelerometry through the assessment of the sleep and physical activity [172]. The relationship between self-scored pain, muscular activity and postural load during cleaning activities was studied in [173], and the authors found a higher muscular activity in the case of low-level pain compared to subjects reporting a higher level of pain.…”

“…In conclusion, objective sensor-based pain monitoring technologies have the potential to help improving the patient's quality of life [312], to understand better the pain biopsychosocial processes and may be of interest in the study of other related conditions [172]. Funding: This work was supported in part by the "Fondo de Investigaciones Sanitarias" (Instituto de Salud Carlos III, Spain) under Grants PI15/00306, in part by the "Fundación Progreso y Salud" (Government of Andalucía, Spain) under Grant PIN-0394-2017, in part by "Fundación Mutua Madrileña" under grant VÍA-RENAL, and in part by the "Eurostars Programme", European Commission, under Grant "FRAIL".…”