Chua, JasonSlater, HelenRowbotham, SamanthaHansen, PaulSmith, Anne JLord, Susan MO'Sullivan, Peter BTory, BreannaStinson, Jennifer NBriggs, Andrew M2026-03-232026-03-232026-03-11J Pain, ISSN: 1526-5900 (Print); 1528-8447 (Online), Elsevier BV, 43, 106257-. doi: 10.1016/j.jpain.2026.1062571526-59001528-8447http://hdl.handle.net/10292/20798Youth (16-24 years) experiencing chronic musculoskeletal pain (CMP) value access to digitally-supportive care. Adopting a three-phase design, we aimed to identify and validate youth's preferences for digital health solutions (DHSs) to support their CMP self-care and measure their preferences for artificial intelligence (AI)-enabled digital coaches and perceived risks of harm. Phase 1 involved focus groups with 20 youth experiencing CMP, applying content analysis to explore the attributes they consider when choosing digitally-supportive care. Phase 2 involved a two-round eDelphi (n=20 youth) to validate attributes identified in Phase 1, rank the importance of digital coach-related attributes, and identify risks of harm with digitally-supportive CMP care. Phase 3 involved two discrete choice experiments (n=41 youth) to measure preferences for digital coach-related attributes and risks of harm. Phase 1 produced 31 discrete attributes of DHSs (11 digital coach-related). Phase 2 validated 31 attributes and identified six risks of harm. Phase 3 identified three most preferred digital coach-related attributes (sample mean[SD] weights representing relative importance): 'Generates a pain self-care plan' (19·6[14·5]%); 'Learns my preferences for my pain self-care' (15·9[12·9]%); and 'Supports my healthcare visits' (11·1[12·4]%). The three most concerning risks of harm were: 'Quality of pain care advice and guidance' (31·8[17·3]%); 'Information being consistent with advice from my healthcare team' (25·8[17·5]%); and 'Data security protections' (14·8[17·6]%). Youth consider a range of attributes and potential harms of DHSs to support their CMP care; a subset appears to be most important. These attributes and risks of harm should be considered in co-design of digitally-supportive CMP care for youth. PERSPECTIVE: The results identify that a subset of digital coach-related attributes and risks of harm dominate youth's preferences for digitally-supportive chronic musculoskeletal pain care. These attributes and risks of harm should be considered in co-design of digital health solutions, and in positioning a solution within a clinical care ecosystem.© 2026 The Author(s). Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc. This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. You are not required to obtain permission to reuse this article.Artificial intelligenceChronic musculoskeletal painDigital heath technologyPreferencesYouth32 Biomedical and Clinical Sciences3202 Clinical Sciences42 Health SciencesPain ResearchNetworking and Information Technology R&D (NITRD)TelehealthChronic Pain7.1 Individual care needs11 Medical and Health Sciences17 Psychology and Cognitive SciencesAnesthesiology3202 Clinical sciences4202 EpidemiologyJournal ArticleOpenAccess10.1016/j.jpain.2026.106257