Defining and validating a multidimensional digital metric of health states in chronic back and leg pain
Chronic pain (CP) is a debilitating condition that extends beyond persistent pain, influenced by physiological and psychological factors. However, clinical trials often evaluate outcomes solely on self-reported pain amplitude. To address this, we aimed to derive a single metric from multidimensional digital data to comprehensively represent wellness in lower back and leg pain. Daily-reported data were collected for five years (>190 K samples, n = 498, from NCT01719055/NCT03240588), comprised of clinical assessments, digitally-reported symptoms, text responses, and smartwatch-based actigraphy. Clustering analysis of the digital data identified five novel symptom clusters. They were validated by comparing centroid distances to standard assessments, revealing five ordinal best-to-worst states (r = 0.34 to r = -0.51, ps < 0.001), even when pain magnitude was similar. Further, patients' text messages about their status associated better with the clusters than pain reports alone. This solution extends beyond a recapitulation of pain level, yielding non-obvious, meaningful states that serve as an actionable metric in CP care.
Authors
- Eric Loudermilk (ORCID: https://orcid.org/0000-0001-6170-427X)
- Amol Patwardhan (ORCID: https://orcid.org/0000-0003-0914-0408)
- René Przkora
- Mohab Ibrahim (ORCID: https://orcid.org/0000-0001-5266-6523)
- James Scowcroft
- Rex Woon (ORCID: https://orcid.org/0000-0002-4961-4180)
- Nathan Miller (ORCID: https://orcid.org/0000-0002-1677-5594)
- Julio Paez
- Todd Turley
- Jeffrey L. Rogers
- Matt McDonald (ORCID: https://orcid.org/0000-0001-6636-2731)
- Jenna Reinen (ORCID: https://orcid.org/0000-0001-5822-585X)
- Brad Hershey (ORCID: https://orcid.org/0000-0003-3994-7544)
- Guillermo Cecchi (ORCID: https://orcid.org/0000-0003-1013-8348)
- Gassan Chaiban
- Dat Huynh
- Louis Bojrab
- Carla Agurto (ORCID: https://orcid.org/0000-0002-0617-4488)
- John Noles
- Richard Rauck
- Kristen Lechleiter
Institutions
- IBM (United States) (US)
- University of Arizona (US)
- Winston-Salem State University (US)
- Ochsner Medical Center (US)
- Boston Scientific (United States) (US)
- University of Florida (US)
- Hope Research Institute (US)
- Medical Advanced Pain Specialists (US)
- Southeast Clinical Oncology Research Consortium (US)
- IBM Research - Thomas J. Watson Research Center (US)
- Summit School (US)
- Spinal Diagnostics and Treatment Center (US)
- Anderson University - South Carolina (US)
Publication Details
- Journal
- npj Digital Medicine
- Published
- 2025-11-21
- DOI
- https://doi.org/10.1038/s41746-025-02084-1
- Citations
- 1
- Primary Topic
- Musculoskeletal pain and rehabilitation
- Type
- article
- Field-Weighted Citation Impact
- 1.39
Funders
- Boston Scientific Corporation