Measurement of emotional and physical functioning among individuals experiencing chronic pain falls within two broad categories: retrospective and momentary. Retrospective measurement uses well-constructed, detailed and sometimes lengthy self-report questionnaires to capture a global assessment of physical and emotional functioning. Retrospective questionnaires typically ask respondents to estimate and summarize their level of functioning across the past week or month. On the other hand, momentary measures are brief and focus on individuals’ immediate emotional and/or physical state. Because of their convenience, momentary measures allow for repeated daily administration and may assist in unveiling important symptom patterns.
Traditionally, repeated administration of momentary measures has relied on a paper-based diary format. However, this format is prone to poor compliance and higher frequencies of missing information. In an effort to improve the quality of information collected, a number of researchers have migrated paper-based diaries to a variety of electronic formats such as personal digital assistants, cellular phones and personal computers. As compared with paper-based diaries, electronic pain diaries tend to be preferred by patients and produce more reliable and accurate information. Recent research has demonstrated that careful use of electronic pain diaries may lead to more tailored treatment and thereby increase the possibility of more meaningful change in patients’ symptoms.
Despite the potential benefit of electronic pain diaries, their use is not widespread in clinical treatment. Routine adoption of electronic pain diaries has been hampered by prohibitive hardware and software costs associated with these forms of assessment. To address this barrier, a simple and easy-to-use computer program called ePain was created that automates the collection of momentary ratings for individuals who experience chronic pain. This program is freeware and can be downloaded at www.scarthmckillop.ca. It is gender-specific, with one version for women and another for men. The program has been designed to be small in size and requires a Windows operating system and a PDF viewer.
The main screen asks the user to (1) rate his or her current pain, mood and level of activity, (2) indicate on the body image those areas that are painful today, and (3) describe how his or her day was. The program assumes that one diary entry will be provided for each day, usually at the end of the day. However, the program permits users to enter as many diary entries as they wish on any given day.
The user indicates areas of pain by drawing on the body diagram. To highlight body areas that are painful, the user clicks the mouse over the appropriate body area, creating a red circle on the selected body area. Right-clicking the mouse erases the red circle.
The program allows the user to review all saved diary entries and to print, save or email any diary entry. An example of a printed diary record is shown in Figure 1.
Displaying Multiple Records
A range of up to 100 records can be viewed at one time. This creates a summary chart that displays an accumulated pain drawing as well as charts of pain, mood and activity ratings across time. In the accumulated pain drawing, red shading is used to depict how frequently specific body areas were selected. The brighter the area, the more frequently that area was selected in the diary records. Figure 2 depicts summary information for a range of records.
Ultimately, the usefulness and acceptance of electronic pain diaries will depend on their accessibility, cost, reliability, technical simplicity and meaningfulness to both patient and provider. Electronic pain diaries are not a panacea, but judicious use of this form of assessment may be helpful when monitoring ongoing treatment or any planned change to a treatment regimen. We hope that our program will be of some benefit to health care providers and their patients and will enhance quality of care.