Table 3.

Participant responses regarding what is missing from the investigator definition of pain flare - Inadequate pain relief for an episode of intense pain that is usually brought about by too much activity

	Participant Quotes
Pain Qualities	“Above the normal range of pain” “Burning sensation, heaviness in joints, sharp and intense pain when knees lock” “Definition of pain has to be broader” “Need to determine ambient level of pain and spikes above that level”	“Not dull pain, more a flare up” “Intense pain for certain activities” “Needs joint specific activity” “Comment about ‘pain control’ is too clinical, would like it to be more specific”
Timing	“Timing should be 2 – 24 hours instead of a shorter term feeling” “Frequency”	“inadequate” fails to capture the idea of occurrence of pain” “Can be more time” “Sudden pain because of activity”
Antecedents	“Activity isn’t the only trigger, also brought on by usual and unusual activity” “At night, not dependent on activity” “Too much activity or stress” “Can happen when sitting (with little activity), too much of anything (standing, sitting, activity)” “Can be other causes—way you sit, way you sleep” “’Too much activity’ not only reason for pain flare”	“Or it comes on while being sedentary, even waking up with a flare or specific activities or motions” “Sometimes brought on by changes in position; wake up at night” “Brought on by activity, but not necessarily ‘too much’ activity, your normal [activity]” “Not always too much activity, could be because of weather or pressure”
Consequences	“Inadequate pain relief should be omitted because I interpret that as meaning that I need to take pain medication for relief”	“Causes [me] to use pain meds [I] don’t typically use” “No pain relief until I stop activity” “Pain flares diminishes activity”