Arthur A. Stone, PhD, and Colleagues at Stony Brook Suggest New Approaches to Measuring Pain and Other Patient Reported Outcomes

Distinguished Professor of Psychiatry Arthur A. Stone, PhD, co-edited a special issue of the journal Psychosomatic Medicine devoted to ambulatory monitoring of biobehavioral processes in health and disease. The issue included an article by Dr. Stone and his colleagues from the Applied Behavioral Medicine Research Institute on Expanding Options for Developing Outcome Measures from Momentary Assessment Data. Thomas Kubiak, PhD, of the Johannes Gutenberg University in Mainz, Germany, co-edited the special issue with Dr. Stone.

In their editorial, Drs. Stone and Kubiak point out that ambulatory monitoring — which includes various techniques of self-report and physiological monitoring — has significantly advanced during the past decade. Researchers have developed new techniques for measuring a broad range of physiological parameters; for performing sophisticated statistical analyses; and for integrating biological, psychological, behavioral and environmental information. The authors expect that these advances “will lead to new theories in psychosomatic medicine and other areas where the behavioral and social sciences interact with biomedical research.”

In the article on expanding options for developing outcome measures, Dr. Stone and his Stony Brook colleagues discussed the feasibility of using summary measures other than a simple average of multiple moments over time to characterize the experience of pain and other self-reported outcomes. Using data from two studies of pain reported by patients with rheumatic disease, they described eight possible measures — including the proportion of ratings of no or minimal pain, the proportion of ratings of moderate to severe pain, and indicators of the maximum levels of pain experienced — that might represent the individual’s experience of pain in clinically meaningful ways.

For the first study, they created histograms representing variations in pain intensity within individuals over time using each of the eight measures. They found that the histograms showed distinctively different patterns in the distribution of pain intensity scores, suggesting that the measures could provide novel information by revealing different facets of the pain experience.

In their second study, they used the eight measures to describe the outcomes of clinical interventions intended to reduce pain by comparing before and after scores of patients who received pain-reducing interventions to the scores of a comparison group of patients whose treatment was not changed. They found that the measures they described in the first study reflected improvement in pain control and corresponded with patients’ global impression of improvement. They concluded that “evaluation of clinical outcomes could be potentially more informative and refined by adopting more than one way of characterizing change.”

Professors Joan E. Broderick, PhD, Stefan Schneider, PhD, and Joseph E. Schwartz, PhD, all from the Department of Psychiatry and Behavioral Science at Stony Brook University were coauthors of the paper.