Graded Chronic Pain Scale Research Articles

Graded chronic pain scale revised: validation in a Veteran sample.

The Graded Chronic Pain Scale (GCPS) is frequently used in pain research and treatment to classify mild, bothersome, and high impact chronic pain. This study's objective was to validate the revised version of the GCPS (GCPS-R) in a US Veterans Affairs (VA) healthcare sample to support its use in this high-risk population. Data were collected from Veterans (n = 794) via self-report (GCPS-R and relevant health questionnaires) and electronic health record extraction (demographics and opioid prescriptions). Logistic regression, adjusting for age and gender, was used to test for differences in health indicators by pain grade. Adjusted odds ratio (AOR) with 95% confidence intervals (CIs) were reported with CIs not including an AOR of 1 indicating that the difference exceeded chance. In this population, the prevalence of chronic pain (pain present most or every day, prior 3 months) was 49.3%: 7.1% with mild chronic pain (mild pain intensity and lower interference with activities); 23.3% bothersome chronic pain (moderate to severe pain intensity with lower interference); and 21.1% high impact chronic pain (higher interference). Results of this study mirrored findings in the non-VA validation study; differences between bothersome and high impact were consistent for activity limitations and present but not fully consistent for psychological variables. Those with bothersome chronic pain or high impact chronic pain were more likely to receive long-term opioid therapy compared to those with no/mild chronic pain. Findings highlight categorical differences captured with the GCPS-R, and convergent validity supports use of the GCPS-R in US Veterans.

The financial and quality of life impact of urgent dental presentations: A cross-sectional study.

This study aimed to: (i) calculate personal financial costs associated with urgent dental attendance; and (ii) investigate the pain-related disability and quality of life impact of dental conditions which result in urgent dental attendance. Data were collected from those presenting with urgent dental conditions to an out-of-hours dental service, a dental emergency clinic (DEC) and five primary care general dental practices across North-East England. A pre-operative questionnaire explored the impact of urgent dental conditions on oral health-related quality of life (OHRQoL) using Oral Health Impact Profile-14 (OHIP-14) and a modified Graded Chronic Pain Scale (GCPS). OHIP-14 yields a maximum score of 56, with a higher score indicating a lower OHRQoL. Personal financial costs were summed to provide a total. These included travel, appointment fees, childcare costs, medication use and time away from work. Data were analysed using one-way anova and multivariable modelling. In total, 714 participants were recruited. The mean OHIP-14 score was 25.73; 95% CI [24.67, 26.79], GCPS CPI was 71.69; 95% CI [70.09, 73.28] and GCPS interference was 49.56; 95% CI [47.24, 51.87]. Symptomatic irreversible pulpitis was the most frequently managed dental emergency and was associated with the highest mean OHIP-14 score (31.67; 95% CI [30.20, 33.15]). The mean personal financial cost of urgent dental care (UDC) was £85.81; 95% CI [73.29, 98.33]. Differences in travel time (F[2, 691] = 10.24, p < .001), transport costs (F[2, 698] = 4.92, p = .004), and appointment time (F[2, 74] = 9.40, p < .001) were significant between patients attending an out-of-hours dental service, DEC and dental practices for emergency care, with a DEC being associated with the highest costs and dental practices the lowest. Diseases of the pulp and associated periapical disease were the most common reason for patients to present for UDC and were the most impactful in terms of OHRQoL and pain in the present sample. Personal financial costs are significant from urgent dental conditions, with centralized services increasing the burden to patients of attending appointments.

Investigation of the relationship between probable sleep bruxism, awake bruxism and temporomandibular disorders using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).

The causal relationship between bruxism and temporomandibular disorders (TMD) is not clear. The present study investigated which TMD are associated with probable sleep bruxism (SB) and awake bruxism (AB) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The study further evaluated the association between probable SB and AB and TMD. A total of 143 patients were selected - bruxers (SB and AB) and non-bruxers. A diagnosis of probable bruxism was made after a physical examination and when the symptoms were detected. The patients were evaluated using DC/TMD. From among Axis I assessment instruments, the TMD Pain Screener, the Symptom Questionnaire and the Clinical Examination Form were used. Moreover, the Graded Chronic Pain Scale (GCPS) (v. 2), the Jaw Functional Limitation Scale-8 (JFLS-8), the Patient Health Questionnaire-4 (PHQ-4), and the Oral Behaviors Checklist (OBC) were applied within the scope of Axis II. Diagnoses of muscle disorders and disk displacement with reduction were significantly more frequent in the SB and AB groups than in non-bruxers. A diagnosis of arthralgia was significantly more prevalent in the AB group than in non-bruxers. The JFLS-8 scores and the TMD Pain Screener scores were higher in the AB group than in the SB group and in non-bruxers. Distress levels, and the GCPS and OBC scores were higher in the SB and AB groups as compared to non-bruxers. The results of binary logistic regression analysis showed that only the OBC score was significantly higher in the TMD subgroup (OR (odds ratio) = 1.228; 95% CI (confidence interval): 1.014-1.488). Both SB and AB were associated with pain-related TMD and intra-articular joint disorders. The muscle disorders and disk displacement with reduction subtypes were associated with SB and AB. Unlike SB, AB was also associated with arthralgia. Bruxers (both SB and AB) displayed parafunctional habits. However, AB was associated with greater functional limitation of the jaw as compared to SB.

Establishment of quantitative indicators for an efficient treatment on masticatory muscle pain.

Although several studies have investigated effective treatments for masticatory muscle pain (MMP), no unified conclusion has been drawn regarding the effectiveness of these treatments. This study aimed to define quantitative indicators for predicting the outcome of MMP treatment. In total, patients aged 20-70 years were recruited and divided into the MMP (n = 24) and control (n = 36) groups, based on the presence of MMP according to the Diagnostic Criteria for Temporomandibular Disorders. At pretreatment, the MMP group was assessed using quantitative indicators such as subjective pain levels, pain duration, graded chronic pain scale (GCPS), and perceived stress scale (PSS). Salivary alpha-amylase (sAA) and interleukin-6 (IL-6) levels were analyzed. The masticatory muscle palpation score and the range of mouth opening were measured. At posttreatment, subjective pain levels, mouth opening, and treatment/medication duration were examined. The PSS and sAA levels were assessed in the control group. sAA levels in the MMP group were significantly higher than those in the control group (p < .05). The masseter muscle palpation score (MPS) showed a positive correlation with IL-6 levels (ρ = 0.503, p < .05) and a negative correlation with nonsteroidal anti-inflammatory drug (NSAID) treatment period (ρ = -0.462, p < .05). The temporalis muscle palpation score (TPS) was positively correlated with pain duration and GCPS grade (ρ = 0.483, p < .05, and ρ = 0.445, p < .05, respectively). Treatment with NSAIDs was effective in the MMP group with high MPS and IL-6 levels, but not in the MMP group with high TPS, pain duration, and GCPS grade.

MDMA-assisted therapy is associated with a reduction in chronic pain among people with post-traumatic stress disorder

Increasing evidence demonstrates 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy (MDMA-AT) may be a safe and effective treatment for post-traumatic stress disorder (PTSD). There is growing interest in MDMA-AT to address a range of other health challenges. Chronic pain and PTSD are frequently comorbid, reciprocally interdependent conditions, though the possible role of MDMA-AT in treating chronic pain remains under-investigated. The present analysis examined the impact of manualized MDMA-AT on chronic pain severity among participants with PTSD who were enrolled in a Phase 2 clinical trial investigating MDMA-AT for PTSD (NCT03282123). Exploratory data from a subset of participants who completed chronic pain measures (n = 32) were drawn from a Phase 2 open-label study sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). Multivariable analysis of variance (ANOVA) was utilized to compare pre- vs. post-treatment Chronic Pain Grade Scale (CPGS) values, adjusting for demographics (age, sex, and ethnicity). K-means clustering was then used to group the sample into three clusters to denote high (n = 9), medium (n = 11), and low (n = 12) baseline pain severity, and the same analysis was repeated for each cluster. Among the 32 participants included in this analysis, 59% (n = 19) were women, 72% (n = 23) were white, and median age was 38 years [interquartile range (IQR) = 31-47]. Overall, 84% (n = 27) reported having pain, and 75% (n = 24) reported disability associated with their pain. Significant reductions in CPGS subscales for pain intensity and disability score, and overall CPGS severity grade were observed among participants in the highest pain cluster (n = 9, p < 0.05), and for pain intensity in the medium pain cluster (n = 11, p < 0.05) post- vs. pre-treatment. Findings demonstrate a high prevalence of chronic pain in this sample of people with severe PTSD and that chronic pain scores among medium and high pain subgroups were significantly lower following MDMA-AT. While these data are preliminary, when considered alongside the frequency of comorbid chronic pain and PTSD and promising efficacy of MDMA-AT for treating PTSD, these findings encourage further research exploring the role of MDMA-AT for chronic pain.

A cross-sectional study to validate an administrative back pain severity classification tool based on the graded chronic pain scale

Treatment of chronic lower back pain (CLBP) should be stratified for best medical and economic outcome. To improve the targeting of potential participants for exclusive therapy offers from payers, Freytag et al. developed a tool to classify back pain chronicity classes (CC) based on claim data. The aim of this study was to evaluate the criterion validity of the model. Administrative claim data and self-reported patient information from 3,506 participants (2014–2021) in a private health insurance health management programme in Germany were used to validate the tool. Sensitivity, specificity, and Matthews’ correlation coefficient (MCC) were calculated comparing the prediction with actual grades based on von Korff’s graded chronic pain scale (GCPS). The secondary outcome was an updated view on direct health care costs (€) of patients with back pain (BP) grouped by GCPS. Results showed a fair correlation between predicted CC and actual GCPS grades. A total of 69.7% of all cases were correctly classified. Sensitivity and specificity rates of 54.6 and 76.4% underlined precision. Correlation between CC and GCPS with an MCC of 0.304 also indicated a fair relationship between prediction and observation. Cost data could be clearly grouped by GCPS: the higher the grade, the higher the costs and the use of health care. This was the first study to compare the predicted severity of BP using claim data with the actual severity of BP by GCPS. Based on the results, the usage of CC as a single tool to determine who receives CLBP treatment cannot be recommended. CC is a good tool to segment candidates for specific types of intervention in BP. However, it cannot replace a medical screening at the beginning of an intervention, as the rate of false negatives is too high.Trial registration The study was conducted using routinely collected data from an intervention, which was previously evaluated and registered retrospectively in the German Registry of Clinical Trials under DRKS00015463 (04/09/2018). Informed consent and the self-reported questionnaire have remained unchanged since the study and, therefore, are still valid according to the ethics proposal.

A Comparison of Relation between Resilience, Locus of Control, Quality of Relationship and Pain Intensity with Dialysis Adequacy in Patients with Peritoneal and Hemodialysis.

Objective: Mental health in people with chronic diseases undergoes many changes due to conflict with the pain caused by the disease, which can have a reciprocal effect on the course and quality of the patient's treatment. The goal of the present study is to compare the correlation between locus of control, relationship quality, pain intensity and resilience with dialysis adequacy and laboratory indicators in peritoneal dialysis and hemodialysis patients. Method : This causal-comparative study was conducted on 30 hemodialysis (HD) and 30 peritoneal dialysis (PD) patients through the convenience sampling method. The data was collected using Pierce Quality Relationship Inventory (QRI), Conner-Davidson Resilience Scale (CD-RISC), Rotter's Locus of Control Scale (RLOC), and Von Korff's Chronic Pain Grade Scale (CPGS), and experimental data collected through blood and urine sampling and analyzed with Fisher's test and multivariate analysis of variance. Results: Conclusion of the Fisher test evinced that there was a significant difference between quality of relationships with parents and amount of Potassium (K), Phosphorus (P) and Parathyroid Hormone (PTH) as well between quality of relationships with friends and amount of Creatinine (Cr), and between the intensity of pain with K and Albumin (Alb) in patients with PD and HD (P < 0.05, P < 0.01). Conclusion of analysis of variance showed that the mean scores of quality of relationships with friends, K, Blood Urea Nitrogen (BUN), Cr, Alb and PTH in the PD group were significantly lower than the mean scores of HD patients (P < 0.05, P < 0.01). Also, mean of dialysis adequacy in patients with PD was significantly higher (P < 0.01). Conclusion: Based on findings, in order to increase dialysis adequacy of patients, along with medical interventions, psychological variables and mental health improvement of patients should also be considered.

Neuroimaging in Breast Implant Illness: An fMRI Pilot Study.

Some women with breast implants report systemic and cognitive symptoms known as breast implant illness (BII), which are very similar to those of fibromyalgia. Functional MRI (fMRI) has shown altered brain activity in fibromyalgia patients. The aim of this pilot study was to investigate whether brain alterations could be observed in BII patients by fMRI. Women aged 18 to 76 with silicone breast implants for cosmetic reasons were recruited through a Dutch online BII support organization (MKS) and through the Maastricht University Medical Center. Study participants comprised 12 women with BII and 12 women without symptoms. Participants completed questionnaires regarding demographic characteristics, medical history, psychosocial complaints (Four-Dimensional Symptom Questionnaire), cognitive failure (Mini-Mental State Examination), and pain intensity and pain-related disability (Chronic Pain Grade Scale). Subsequently, brain images of all participants were obtained by resting-state fMRI and diffusion tensor imaging in a 3-T MRI scanner (Siemens Medical System, Erlangen, Germany). Eleven BII patients and 12 healthy controls were included in the analysis. Baseline characteristics were similar in the 2 groups and the mean silicone exposure was 15 years. Patients scored significantly higher than controls on both pain intensity and disability. Patients scored worse on depression, somatization, distress, and anxiety compared with asymptomatic women. Mini-Mental State Examination scores were normal. However, the analyses of both functional connectivity and structural integrity showed no significant differences between the 2 groups. This pilot study showed no evidence of brain alterations in BII patients. However, patients scored significantly worse on psychosocial symptoms than controls. Psychological factors appear to play an important role in BII and should be further investigated.

Psychosocial profiles and their correlation with physical diagnosis in temporomandibular disorders, a preliminary report

ABSTRACT Objective To assess representative psychosocial features in a group of temporomandibular disorder (TMD) patients from Jordan using Axis II of the Diagnostic Criteria for TMD (DC/TMD) protocol. Methods Ninety-eight TMD patients were examined according to Axis I DC/TMD protocol in addition to assessment of their pain-related disability, psychological distress, and stress reactivity. Results Just under half of the patients (49%) had high intensity of characteristic pain (self-reported TMJ-related pain) and one-third (32%) had high levels of pain-related disability. Furthermore, significant proportions of patients expressed moderate-severe degrees of distress and stress reactivity (41% and 39%, respectively). Significant correlations were identified between the Graded Chronic Pain Scale (GCPS) and each of the pain-related TMD subgroups. Conclusion TMD patients are susceptible to high levels of pain-related psychosocial impairment, and clinicians should be aware of the possible correlations between the physical TMD diagnosis and specific psychosocial features during treatment planning.

0616 Retrospective Pain Reports in Obstructive Sleep Apnea Patients Relate to Age, Sex, BMI, Insomnia and Depression Scales, Not to Polysomnographic Measures of Sleep and Respiration

Abstract Introduction OSA was found to alter pain experience, presumably due to apnea-related hypoxia and sleep disturbance. However, types of pain measures, demographic and subjective variables, such as mood, may influence pain experience in OSA. Presently, retrospective pain reports of patients referred for OSA evaluation were analyzed as a function of PSG measures, demographic variables, and self-reported mood and insomnia symptoms. Methods On the evening of a diagnostic in-lab PSG, patients reported pain intensity in the preceding 6 months (PI, rage 0-10, Chronic Pain Grade Scale), symptoms of depression (Center for Epidemiologic Studies Depression Scale-Revised, CESDR) and insomnia (Insomnia Severity Index, ISI). PI was regressed on age, sex, BMI, total sleep time (TST), sleep stage percentages, sleep efficiency, WASO, awakenings, respiratory arousal index, AHI, SpO2% nadir, time below SpO2 90%, desaturation index, CESDR and ISI using a stepwise entry. Results A total of 1293 patients with ≥2 hours of PSG-defined sleep completed the questionnaires; 3% Asian, 42% black, 5% Hispanic, 32% white; 62% women; 66% had OSA (AHI≥5); Mage=58.7±13.8, MBMI=33.8±7.3, MPI=3.5±3.1; MISI=12.9±6.9; MCESDR=14.7±13.1, MAHI=17.6±22.9, MSpO2%nadir=84.9±9.0. Higher PI was associated with female sex (p&amp;lt;0.001, R2=2.6%), older age (p&amp;lt;0.001, R2=3.7%), higher BMI (p&amp;lt;0.001, R2=2.5%), higher ISI (p&amp;lt;0.001, R2=4.5%), higher CESDR (p&amp;lt;0.001, R2=2.3%) and longer TST (p=0.028, R2=0.4%). No other sleep or respiratory variables related to PI. No significant interactions with AHI≥5 were present. No differences between OSA (AHI≥5) and no-OSA groups were present on PI, ISI or CESDR after controlling for age, sex and BMI. Conclusion Retrospective reports of pain intensity were unrelated to PSG measures of sleep and respiratory disturbance. Female sex, older age and higher BMI related to higher PI regardless of the OSA diagnosis and collectively accounted for 8.8% of the PI variance. Symptoms of insomnia and depression related to higher PI independently of OSA, accounting for 4.5% and 2.3% of the PI variance, respectively. As in prior research OSA was associated with insomnia and depression, these variables may mediate the relationship between OSA and pain. Support (If Any) None

Trajectories of Depression, Post-Traumatic Stress, and Chronic Pain Among Women Who Have Separated From an Abusive Partner: A Longitudinal Analysis.

This longitudinal study explored changes in women's health after separation from an abusive partner by characterizing the trajectories of their mental health (depression and post-traumatic stress disorder [PTSD]) and physical health (chronic pain) over a 4-year period. We examined how the severity of intimate partner violence (IPV) affected these trajectories, controlling for selected baseline factors using 5 waves of data collected from a community sample of 309 English-speaking, Canadian women. IPV severity was measured using the Index of Spouse Abuse where women were asked to consider the entire period of their partner relationship up to present at wave 1 and to rate their IPV experiences in the previous 12 months at waves 2-5. Mental health was measured using established self-report measures of depression (CESD) and PTSD (Davidson Trauma Scale), while chronic pain was measured using the Chronic Pain Grade Scale. Trajectories were estimated using MLM techniques with severity of IPV and selected co-variates (time since separation, age, financial strain) included. Our results show that women's health improved significantly over time, although significant levels of depression, PTSD symptoms and disabling chronic pain remained at the end of wave 5. Regardless of time since separation, more severe IPV was associated with higher levels of depression, PTSD, and disabling chronic pain, with IPV having a stronger effect on these health outcomes over time, suggesting cumulative effects of IPV on health. The results of this study contribute to quantifying the continuing mental and physical health burdens experienced by women after separation from an abusive partner. Increased attention to the long-term effects of violence on women's health beyond the crisis of leaving is critically needed to strengthen health and social services and better support women's recovery and healing.

Does Exposure to Maltreatment in Childhood Contribute to Differences in Pain Outcomes in Adulthood?

Childhood maltreatment has been linked with chronic pain in adulthood, primarily through retrospective studies. Our ongoing longitudinal study in women with and without a history of documented childhood maltreatment (CM), the Female Adolescent Development Study (FADS), was leveraged to comprehensively and prospectively examine pain characteristics in a subset of adult women. Twenty-nine women (Mage=28.24, SD=1.19) with (n=15) and without (n=14) a history of CM completed surveys assessing the number of pain locations (widespread pain index, WPI) and severity of somatic symptoms (SS) over the past 3-months, the Graded Chronic Pain Scale (GCPS) to assess pain intensity and interference over the past 6-months, and the Comprehensive Trauma Interview to assess interpersonal violence exposure in adulthood (IPVA). Independent samples t-tests were conducted to compare pain outcomes (WPI; SS; WPI + SS for a Total Symptom Score; and GCPS) between participants with and without a history of CM. We also explored the impact of IPVA on outcomes. Women with a history of CM reported more pain locations (MWPI=2.20 vs. 1.71, d=.19), greater symptom severity (MSS=5.67 vs. 3.86, Cohen's d=.60), and greater Total Symptom Scores (M=7.87 vs. 5.57, d=.49). Pain intensity and pain interference on the GCPS were also higher for women with a CM history (Mintensity=45.95 vs. 30.00, d=.64; Minterference=35.24 vs. 29.52, d=.19). Most women who experienced CM also experienced IPVA. Comparisons between those who experienced IPVA versus those who did not yield similar results to that of CM, with more robust effect sizes. Preliminary results suggest that women with a history of CM are at greater risk for chronic pain, pain interference, and higher severity of somatic symptoms in adulthood. This risk may be amplified among those who have experienced both CM and IPVA. The underlying mechanisms by which adversity influences risk for chronic pain needs further study. Supported by Cincinnati Children's Research Innovation/Pilot Funding Program - Grant number: RIP_020821-020722.

Exploring the Allostatic Load of Pain, Interference, and the Buffering of Resilience

Chronic pain contributes to allostatic load (AL). Individuals with protective psychosocial and biobehavioral factors report lower levels of clinical pain. We have previously shown a relationship between a resilience index, telomere length, and brain structure. This study aims to assess the relationships between AL, a resilience index, and clinical pain/interference. In this study, 193 Non-Hispanic Black and non-Hispanic White adults 45-85 years old, with/without knee pain participated. Data collected included sociodemographics, health history, Graded Chronic Pain Scale (GCPS), and blood samples. AL score was determined by a high risk value of 1 for each measure in the upper quartile for systolic blood pressure, diastolic blood pressure, waist-to-hip ratio, heart rate, fibrinogen, c-reactive protein, and cortisol, and the lower quartile for insulin-like growth factor-1, albumin, and dehydroepiandrosterone (0-10 score). The resilience index was comprised of tobacco use, waist-to-hip ratio, optimism, affect, active coping, perceived stress, and social support. Two-level scoring was used based on clinical norms or median split with higher scores indicating greater resilience (0-8 score). Spearman correlations and adjusted regression analyses were completed using SAS V 9.4. Resilience was inversely associated with GCPS Intensity (rs=-0.26, p=0.0004) and Interference (rs=-0.32, p<0.0001). GCPS Intensity (coefficient=0.16856, p=0.0198) and Interference (r=0.23978, p=0.0008) were positively associated with AL. The resilience index (t=-2.07, p=0.0395) was predictive of AL in an adjusted analysis including age, sex, and ethnicity/race but was not significant when including GCPS Intensity or interference. Resilience was associated with pain and AL, however a biological buffering effect for pain was not demonstrated. AL is a more dynamic measure than telomere length. Additionally, the current AL composite is relative to the sample, a clinically validated measure may be more informative. Further development and refinement of a biologically sensitive resilience index would have significant clinical utility. Grant support from National Institutes of Health/National Institute on Aging [R01AG054370; R37AG033906; T32AG049673; P30 AG059297-01]; the University of Florida Clinical and Translational Science Institute [UL1TR000064]; the University of Alabama at Birmingham Center for Clinical and Translational Science Institute [UL1TR000165] and the Inter-NIA Center Pilot Proposals on Life Course Perspectives on Aging and Resilience and Reserve in Aging.

PREVALENCE OF TEMPOROMANDIBULAR DISORDERS AMONG ORTHODONTIC PATIENTS (CROSS-SECTIONAL CLINICAL SURVEY)

Orthodontic treatment as a risk factor for the development of temporomandibular disorders (TMD) has been a controversy in literature. The aim of this study was to evaluate the prevalence of TMD, as defined in the Diagnostic Criteria (DC)/TMD Axis II, among orthodontic patients. A cross-sectional study (N=180) consisted of 3 groups: 60 control patients seeking orthodontic consultation, 60 patients undergoing orthodontic treatment for 3-5 months, 60 patients undergoing orthodontic treatment for 10-14 months. Patients answered a structured questionnaire that rated their oral parafunctions according to the Oral Behavior Checklist (OBC), pain intensity levels according to the Graded Chronic Pain Scale (GCPS), jaw functional limitations according to the Jaw Functional Limitation Scale 20 (JFLS-20), psychosocial factors (PHQ-9) and somatization levels (PHQ-15). The Chi Square test showed a statistically significant difference p-value=0.001 among both active orthodontic groups (3-5 months/10-14 months) regarding masticatory limitation (53.3%), vertical mobility limitation (41.7% for 3-5 months and 55.0% 10-14 months) and verbal &amp; emotional expression limitation (53.3% 3-5 months and 66.7% 10-14 months). The findings revealed that as orthodontic treatment progresses, the limitation increases. Moreover, no statistical significance was observed between the three groups regarding oral parafunctional habits, chronic pain levels, psychosocial status and somatization. Orthodontic treatment is not a major factor associated with the symptoms of the TMD. Further prospective studies are needed to evaluate the true role of orthodontic treatment in the development of TMD.

Pain characteristics, activity limitation and their influence on health-seeking behaviours of community-dwelling older adults with osteoarthritis in Nigeria

Background: It is postulated that osteoarthritis (OA) patients' health-seeking behavior depends largely on the disease severity and loss of function. Objective: This study aimed to assess the pain characteristics, activity limitations, and health-seeking behaviors of older adults with OA in Nigeria. Methods: A cross-sectional survey was conducted among 230 purposively selected community-dwelling older adults in a semi-urban setting in Nigeria. Pain characteristics, activity limitations, and health-seeking behavior were assessed by an interviewer using the Chronic Pain Grade Scale, Western Ontario and McMaster Universities Arthritis Index, and Health-Care Seeking Behaviour Questionnaire, respectively. Data were analyzed using descriptive statistics and inferential statistics (chi-square and multiple regression) to predict factors influencing health-seeking behavior, and we set the alpha level at p&lt;0.05. Results: Pain at the knee (73.0%) was the most defining feature of OA, and it was typically severe (59.1%), frequent (51.3%), felt deep in the bone (47.0%), and associated with morning stiffness (27.4%). OA led to severe activity limitation (54.3%), and 51.7% of the respondents had an overall negative health-seeking behavior. Furthermore, activity limitation was significantly associated with religion (p=0.008) and pain severity (p=0.001). Similarly, the age (p=022), sex (p=0.006), marital status (p=0.005), and ethnicity (p=0.018) were significantly associated with health-seeking behavior. In addition, health-seeking behavior was predicted by cost, preference, ethnicity, employment, marital status, and limitation inactivity. Conclusion: OA pain is prevalent among community-dwelling older adults, it imposes a severe limitation on activities of daily living, and sociodemographic factors influenced the health-seeking behaviors of patients with OA.

Characteristics of back pain in young adults and their relationship with dehydration: a cross sectional study

Background: Low back pain (LBP) is one of the major factors impairing the quality of life and is the most frequent cause of disability. Inadequate water intake is believed to be the predisposing factor for LBP particularly in the younger population. It is commonly seen that the incidence of LBP has been on the rise in people between 20-40 years of age. Thus, the basic aim of this study is to find a potential relationship between dehydration and LBP among young adults. Methods: This cross-sectional study was conducted from medical students and practicing doctors of 21-39 years from March-May 2019. Characteristics of pain along with the daily activities of patients were assessed. The severity was assessed by using the Graded Chronic pain scale (GCPS). Results: Out of a total of 426 participants, 84.74% had LBP. Of these, 44.3% complained of having it more than once a week, with a duration usually between 1-7 days. More than half of the patients had their routines disturbed because of this pain. Most of the participants complained of an episodic increase in summers. The majority (75.9%, n=274) drank 5-9 glasses of water a day, 64.5% of them were of opinion that their daily water consumption was enough, while 61.5% felt an association between dehydration and LBP. According to the GCPS, one-third of the population had chronic pain of grade I, and the other third had grade IV. Conclusions: It can be concluded that with the increase in the pace of life, many of the young adults have a reduced intake of water, and due to a probable relationship between LBP and dehydration, this might be a reason for the increasing propensity of LBP in them. There is a need for further work in this regard.

Train at home, but not alone: a randomised controlled multicentre trial assessing the effects of live-streamed tele-exercise during COVID-19-related lockdowns

ObjectivePublic life restrictions associated with the COVID-19 pandemic caused reductions in physical activity (PA) and decreases in mental and somatic health. Considering the interplay between these factors, we investigated the...

Graded Chronic Pain Scale: Validation of 1-Month Reference Frame.

The 1-month Graded Chronic Pain Scale (GCPS) commonly used in clinical studies has never been validated. This study compares the GCPS 1-month with the 6 months version for reliability and validity. The Validation Project included 521 participants with at least one temporomandibular disorder for cross-sectional data and 74 participants for test-retest data. Internal reliability, stability, and construct validity were used for testing the 1-month version. Comparisons were made between the 2 versions for characteristic pain intensity (CPI), interference, and chronic pain grade (CPG). For GCPS 1-month, internal consistency for pain intensity and interference was high (Cronbach α=0.87 and 0.94, respectively), and temporal stability was high for CPI (intraclass correlation coefficient [ICC]=0.91), interference (ICC=0.85), and CPG (weighted κ=0.88). ICC or κ between the 2 versions was 0.78 (CPI), 0.66 (interference), and 0.69 (CPG); high-impact pain, in contrast, was 0.50. Construct validity exhibited higher correlations with predictor variables for 1-month version attributes of CPI, interference, and CPG. Modified Bland-Altman plots indicated that both versions measure CPI well. Overall, reliability of the 1-month GCPS is equal to or better than the 6-months version for pain intensity, disability days, pain interference, CPG, and high-impact pain. However, consistency between versions is lower for measures of disability days and interference, and for the derived measures of CPG and high-impact pain; highly skewed distributions and increasing disagreement in reported status over the time periods affect the measures of function. Therefore, we recommend that GCPS-1 month only be used to calculate pain intensity and pain interference.

Importance of the Graded Chronic Pain Scale as a Biopsychosocial Screening Instrument in TMD Pain Patient Subtyping.

To compare the suitability of Graded Chronic Pain Scale (GCPS) pain intensity and interference assessments (GCPS version 1.0 vs 2.0) for the biopsychosocial screening and subtyping of Finnish tertiary care referral patients with TMD pain. Altogether, 197 TMD pain patients participated in this study. All patients received Axis II specialist-level psychosocial questionnaires from the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD-FIN) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD-FIN), as well as questionnaires for the assessment of additional pain-related, biopsychosocial, and treatment-related variables. Clinical examinations were performed according to the DC/TMD Axis I protocol. The patients were categorized into TMD subtypes 1, 2, and 3 (GCPS I and II-low; II-high; and III and IV, respectively) based on their biopsychosocial profiles according to GCPS versions 1.0 and 2.0. The distribution of TMD pain patients into TMD subtypes was similar according to the GCPS 1.0 compared to the GCPS 2.0. Over 50% of the patients were moderately (TMD subtype 2) or severely (TMD subtype 3) compromised. Patients in subtype 3 experienced biopsychosocial symptoms and reported previous health care visits significantly more often than patients in subtypes 1 and 2. Patients in subtype 2 reported intermediate biopsychosocial burden compared to subtypes 1 and 3. TMD pain patients differ in their biopsychosocial profiles, and, similarly to the GCPS 1.0, the GCPS 2.0 is a suitable instrument for categorizing TMD tertiary care pain patients into three biopsychosocially relevant TMD subtypes. The GCPS 2.0 can be regarded as a suitable initial screening tool for adjunct personalized or comprehensive multidisciplinary assessment.

A formulation of Clausena anisata (Willd.) Hook. f. Ex Benth and Cassia sieberiana DC. alleviates the symptoms associated with osteoarthritis: a single-blind, randomised controlled trial of a traditional Ghanaian remedy

BackgroundClinical validation of herbal medicinal products is important for their widespread acceptance and application. In this single-blind, randomised controlled trial, a traditional Ghanaian herbal medicine formulation with Clausena anisata (Willd.) Hook. f. ex Benth and Cassia sieberiana DC. as ingredients was evaluated for its safety and effectiveness in the management of patients with osteoarthritis. The formulation for the purposes of this study was labelled with the code GC-500.MethodsA total of 57 participants were randomly assigned to receive either this herbal remedy, GC-500, or the control treatment of diclofenac. Subjects were then followed up for a period of 8 weeks using a modified Graded Chronic Pain Scale (GCPS) for their efficacy assessments. The control treatment comprised 13 subjects and the GC-500 group 44 subjects.ResultsUpon completion of the study, 28 (63.63%) subjects in the GC-500 group attained the primary outcome, (GCPS of Grade 0) compared to 5 (38.46%) subjects in the control group. Improvement in disease indicators such as characteristic pain intensity, disability score and disability days was comparable between the GC-500 and diclofenac. Intensity of pain reduced after 8 weeks of treatment; disability score and disability days also declined indicating an improvement in the quality of life of subjects. GC-500 was also shown to be safe for human use.ConclusionThe herbal medicine formulation GC-500, provides a credible treatment option for managing the pain associated with osteoarthritis.Trial registrationThis study was retrospectively registered with the Pan-African Trial registry with a Trial ID: PACTR201909643671755 on 25th September, 2019 at https://pactr.samrc.ac.za/Search.aspx