Marc O. Martel

Background Clinical interventions aim to improve the daily life experiences of patients. However, past research has highlighted important discrepancies between commonly used assessments (e.g. retrospective questionnaires) and patients' daily life experiences of pain. These gaps may contribute to flawed clinical decision‐making and ineffective care. Recent work suggests that real‐time, task‐based clinical assessments may help reduce these discrepancies by adding predictive value in explaining daily life pain experiences. This study aimed to investigate these relationships by evaluating whether task‐based measures of sensitivity to physical activity (SPA) predict daily life pain and mood, beyond traditional pain‐related questionnaires. Methods Adults with back pain (<6‐month onset) answered pain‐related questionnaires and completed a standardized lifting task. SPA‐Pain, SPA‐Sensory and SPA‐Mood were, respectively, assessed as task‐evoked changes in pain intensity, pressure pain threshold (back, hands), situational catastrophizing. Over the next 9 days, daily life pain and mood were assessed using smartphone‐based ecological momentary assessment (EMA‐Pain and EMA‐Mood, respectively) with stratified random sampling. Data analyses estimated fixed effects ( b ) using multilevel linear modelling with random intercepts. Results Median EMA completion per participant was 66.67% ( n = 67 participants). After controlling for covariates, SPA‐Pain was associated with EMA‐Pain ( b = 0.235, p = 0.002) and SPA‐Psych approached significance with EMA‐Mood ( b = −0.159, p = 0.052). Conclusions Task‐based assessment of SPA helps explain daily life pain and mood among adults with back pain, beyond traditional questionnaires. Adding task‐based assessment of SPA may achieve a more complete picture of pain and mood in daily life, offering clinicians better guidance when prescribing activity‐based interventions that are designed to modify daily life behaviour, such as graded activity. Significance This study found that, among people with back pain, task‐based measures of sensitivity to physical activity contribute additional predictive value for daily life pain and mood beyond self‐report questionnaires. Findings suggest that real‐time, task‐based measures may help mitigate some of the shortcomings that are commonly associated with retrospective questionnaires.

Objective Many patients with fibromyalgia (FM) report using cannabis as a strategy to improve pain. Given that pain often co‐occurs with symptoms of anxiety and depression (i.e., negative affect) and sleep problems among patients with FM, improvements in these symptoms might indirectly contribute to reductions in pain intensity following cannabis use. The main objective of the study was to examine whether changes in pain intensity following initiation of medical cannabis among patients with FM could be attributed to concurrent changes (i.e., reductions) in negative affect and sleep problems. Methods This was a 12‐month prospective cohort study among patients with FM (n = 323) initiating medical cannabis under the care of physicians. Patients were assessed at baseline, and follow‐up assessment visits occurred every 3 months after initiation of medical cannabis. Patients’ levels of pain intensity, negative affect, and sleep problems were assessed across all visits. Results Multilevel mediation analyses indicated that reductions in patients’ levels of pain intensity were partly explained by concurrent reductions in sleep problems and negative affect (both P < 0.001). This remained significant even when accounting for patients’ baseline characteristics or changes in medical cannabis directives over time (all P > 0.05). Conclusion Our findings provide preliminary insight into the potential mechanisms of action underlying pain reductions among patients with FM who are using medical cannabis. Given the high attrition rate (i.e., 75%) observed in the present study at 12 months, our findings cannot be generalized to all patients with FM who are using medical cannabis.