• Piotr Gruszka, Christina Stammen, Nicolai Bissantz, and Mark P Jensen.
• Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany.
• Eur J Pain. 2019 Oct 1; 23 (9): 1674-1687.

BackgroundFocusing on pain while completing a pain diary might have detrimental effects on pain intensity. Inverted comfort ratings might be used instead.MethodsA fully remote app-based registered experiment was conducted to investigate the effects of a pain versus comfort diary on 7-day recall ratings of pain intensity during a 3-week period. The diary included questions about past, current and expected pain or comfort. Randomization took place by the study app, thereby controlling for effects of experimenter bias.ResultsContrary to the study hypothesis, multilevel regression showed a more pronounced decrease in 7-day recall ratings of pain in the group who rated pain intensity daily (n = 184) than in the group who rated comfort daily (n = 205, B = -0.17, p = 0.034). There were no between-group differences in secondary outcomes (comfort, depressive symptoms, pain interference and happiness). Exploratory analyses revealed more pronounced decreases in pain intensity in participants who experienced less frequent pain in the previous 6 months. Correlations between pain and comfort ratings decreased from -0.39 at baseline to -0.06 after 3 weeks.ConclusionsThe findings do not support the potential beneficial effects of replacing diary ratings of pain intensity with diary ratings of comfort. The unexpected decreases among those who completed daily pain diaries might have been due to the inclusion of questions about expected pain. Decreasing correlations between pain and comfort ratings suggest that comfort ratings are not merely inverted pain ratings; rather, they appear to assess a domain distinct from pain intensity.SignificanceThe positive effects of pain diaries on pain trajectories appear to constitute a reliable effect and not a methodological artefact. Pain diaries should be investigated systematically to identify ways to optimize their effects on clinical outcomes. Comfort diaries, however, do not appear to be an efficacious substitute for pain diaries; if the current findings replicate, they indicate that primary care practitioners should continue to use pain diaries in clinical care.© 2019 European Pain Federation - EFIC®.

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