Pattern and Grading of Pain among Patients Attending the Periodontology Clinic in a Tertiary Hospital in Nigeria

Abstract

Objective: To assess the pattern and grading of pain among patients presenting at the preventive dentistry clinic, UPTH using the Numeric rating scale (NRS). It also aims to compare the participants’ pain response on NRS to their response on Verbal rating scale (VRS).

Methods: This was a descriptive, cross-sectional study conducted among consecutive patients who presented with dental pain at the preventive dentistry clinic, UPTH. A self-administered questionnaire was used to obtain information on sociodemographic, grading of pain using the NRS and VRS.  The Numeric rating scale is a unidimensional pain, with a 11-point numeric scale ranging from ‘0’ representing ‘no pain’ to ‘10’ representing the other pain extreme (‘pain as bad as you can imagine’ or ‘worst pain imaginable’. The Verbal rating scale, also a unidimensional pain scale, consists of a number of descriptors designed to describe pain intensity and duration, the most common descriptors used are “no pain”, “mild pain”, “moderate” and “severe or intense pain”⁾. In this study, NRS score 0 cm was categorized as no pain, 1-3cm mild pain, 4-6cm moderate pain and 7-10cm severe pain. Statistical analysis was done using the Statistical Product and Service Solution, SPSS version 25.0. Statistical significance was considered at p ≤ 0.05. 

Results: One hundred and forty-five participants were enrolled into the study, comprising of 87 (60.0%) females and 58 (40.0%) males. Age range of the participants was 17-82 years with mean age of 39.79 ± 16.79 years. Participants within the 20-29 years age group (52.3%) presented more with NRS pain score 7-10 (severe pain). 37(42.5%) and 39(44.8%) of the female participants presented with pain score NRS 4-6 (moderate pain) and NRS pain score 7-10 (severe pain) respectively. More of the participants in the lower social class (49.3%) presented with NRS pain score 7-10 (severe pain). Participants who had visited the dental clinic 6-12 months ago (45.5%), and >12 months ago (47.1%), presented with NRS pain score 7-10 (severe pain). Chronic periodontitis (n=55) was the most common clinical diagnosis among the participants, with a female predominance (67.3%). 47.3% of participants with chronic periodontitis had NRS pain score 7-10 (severe pain). The lower left quadrant (26.21%) was the most common quadrant with pain. There was a strong, positive, and significant correlation between the NRS and the VRS pain assessment instruments (Spearman’s rho rank correlation = 0.757; 95% CI: 0.677 – 0.819, p value <0.0001).

Conclusion: Numeric rating scale pain score 7-10, was associated with 20-29 years age group, female gender, lower socioeconomic class and previous dental visits ≥ 6 months. Chronic periodontitis was the commonest cause of pain and the lower left quadrant was the most commonly affected quadrant. There was a strong, positive and significant correlation between the NRS and VRS.