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Grading the severity of chronic pain
Abstract
This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients. Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients. A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale. Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity. Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability. Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting. For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up. Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade. Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset. Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks. Chronic Pain Grade and pain-related functional limitations at 3-year follow-up. Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required. Pain persistence, measured by days in pain in a fixed time period, provides useful additional information.
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“Although conceptually appealing, this hotly debated7 approach does not consider the multidimensional nature of chronic pain, namely, the presence of activity limitations and participation restrictions,5,17,30–36 classifications recognized by the World Health Organization.37”
From Prevalence and Profile of High-Impact Chronic Pain in the United States (2019) · cites this paper as [35]
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Metadata
- Authors
- Von Korff, M., Ormel, J., Keefe, F. J., & Dworkin, S. F.
- Affiliations
- Group Health Cooperative (US)
- Duke Medical Center (US)
- University of Washington (US)
- Venue
- Pain
- Published
- 1992-08
- Volume
- 50
- Issue
- 2
- Pages
- 133-149
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W1966128258
- Cited by
- 3,022
- References
- 25
- Citations by year
- 2026: 68 · 2025: 147 · 2024: 139 · 2023: 120 · 2022: 163 · 2021: 174 · 2020: 168 · 2019: 161 · 2018: 147 · 2017: 118 · 2016: 132 · 2015: 121 · 2014: 128 · 2013: 122 · 2012: 106
- FWCI
- 8.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 HS-06168, P01 HS06344)
- National Institute of Dental and Craniofacial Research (P01 DE08773, P01DE008773)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- pain intensity, pain-related disability, pain persistence, back pain, headache, temporomandibular disorders, functional limitations, depression, opioid analgesic use, primary care patients, unemployment
- MeSH terms
- Adolescent, Adult, Aged, Behavior, Chronic Disease, Depression, Employment, Humans, Middle Aged, Models, Biological, Narcotics, Pain, Pain Measurement, Statistics as Topic, Temporomandibular Joint Dysfunction Syndrome
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