Do we really know how pain changes? Or even how pain starts?  This is why pain tracking is important.  Many of us know its fairly normal to feel pain when we have an injury such as a small cut or bruise.  We also know pain can occur with more serious injuries such as ankle sprains. But what about the millions of cases of neck or back pain?

How does pain change?

Often the onset of neck or back pain does not involve one single memorable event.  For some the pain will resolve after a few weeks.   In many cases the pain  continues for years, often as short episodes re-occurring without warning.  Unfortunately,  not much is known about what happens in between pain onset and resolve or what happens during a re-occurring episode.

In recent article  ‘What have we learned from ten years of trajectory research in low back pain?’ appearing in BMC Musculoskeletal Disorders, Kongsted and colleagues (2017) reviewed a number of studies that tracked pain intensity in individuals with low back pain.  The review examined 10 cohorts and assessed the results from data collected from as early as 2006.

A proposed terminology of how pain changes over the long-term were as follows:

  • Persistent pain
  • Fluctuating pain
  • Episodic pain (including a single episode of pain)

Kongsted and colleagues (2017) suggested three terms for describing how pain changes and are simply portrayed in Figure 1:

Pain intensity change terms

Figure 1: Suggested terminology on how pain intensity changes over time as re-drawn from Figure 3 in Kongsted and colleagues (2017) https://doi.org/10.1186/s12891-016-1071-2. Reproduced under Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/). Graphs re-drawn, colored, and placed side-by-side to enhance comparison.

From the review,  the most frequent pain tracking assessment was made fortnightly, that is once every two weeks.  Kent and colleagues (2012) showed  pain tracking these large time intervals does not produce simple smooth lines like those in Figure 1 .

Infrequent ratings are likely due to the technical barriers of collecting daily pain ratings.

Indeed technical barriers may be why we lack information on pain map patterns.  This may also explain why in both research and clinical settings, after the onset, pain is rarely monitored to the extent necessary to capture vital information about how pain changes.  This is unfortunate given that our understanding of how pain transitions from acute to chronic  remains elusive.   So where does that leave us?

Look to the Scheduler 

We can begin by finding out what happens in between by asking patients to tell us.  As clinicians and professional researchers, we can start by tracking pain as a pain map of the body, the intensity, area, location, and pain type.  We can track pain by way of digital pain charts today, tomorrow and the next day.  Patients look to clinicians for guidance and reassurance.  As a basic expectation clinicians look to pain scientists for explanations.

From a clinicians perspective, given that each patient can be unique, common sense tells us that if we want to make any sort of prediction we must look to the patient’s pain history.  The history may include yesterday but it could also  last month or one year ago.   But how can we look back if their is no pain chart record or documentation?  How can we listen if we don’t empower our patients with pain tracking tools to tell us what is happening.

The Navigate Pain ‘Scheduler’ was created so patient’s can tell us what’s happening. 

Navigate Pain has a custom calendar feature known as  the Scheduler.   By  choosing a start and end date  it is possible to capture what is happening today, tomorrow and the next day.  For example a patient can enter his/her information about pain intensity, area and location up to three times per day over several weeks.  These multiple entries make it possible to see how pain is changing.  The pain charts also serve as documentation.

Change is the end result of all true learning – Leo Buscaglia

Let the pain map emerge

The Scheduler prompts patients to enter their information on their phone, computer or tablet, which can improve reporting compliance.  This level of detail  captures the incremental and daily changes.  If continued over one to three weeks a more specific pain map of the body and pattern may emerge.  Bu using the Navigate Pain timeline viewer the pain maps can viewed in a series.

Pain area shape division changes

An example of how neck pain may start in a distinct bodily area and how additional areas may appear, spread and increase in area over time.

We can collect a series of pain charts using the Scheduler. The series of pain charts can inform us about the trajectory of the pain reports.  The pain report includes intensity, pain type in relation to pain maps of the body.  The location of pain may shift or spread.  

Pain may spread or suddenly appear distant to the original pain location.  This knowledge is less subjective than the pain intensity score itself.  Pain is either present or absent.

Scientists and the Scheduler 

To date, we know that chronic pain (i.e. pain lasting longer than 3 months) can be associated with a change in the central nervous system (CNS) known as central sensitization. Today, the Navigate Pain Scheduler is helping scientists answer additional deep questions such as how and why does pain persists.  Such a question is notoriously  persistent within the scientific community (Yes, pun intended).

The Scheduler is a core element of the Navigate Pain software that serves scientific and clinical teams.   We will only begin to learn more by observing and listening to what patients have to tell us.  Can it be any other way?

 

Read More about Navigate Pain

References

Alice Kongsted, Peter Kent, Iben Axen, Aron S. Downie , and Kate M. Dunn. What have we learned from ten years of trajectory research in low back pain?  BMC Musculoskeletal Disorders. 2016: 17:220.  

Kent P, Kongsted A. Identifying clinical course patterns in SMS data using cluster analysis. Chiropr Man Therap. 2012;20(1):20.