title: Grading the intensity of nondental orofacial pain: identification of cutoff points for mild, moderate, and severe pain.
abstract: BACKGROUND
  When assessing pain in clinical practice, clinicians often label pain as mild, moderate, and severe. However, these categories are not distinctly defined, and are often used arbitrarily. Instruments for pain assessment use more sophisticated scales, such as a 0-10 numerical rating scale, and apart from pain intensity assess pain-related interference and disability. The aim of the study was to identify cutoff points for mild, moderate, and severe nondental orofacial pain using a numerical rating scale, a pain-related interference scale, and a disability measurement.
  
  
  METHODS
  A total of 245 patients referred to the Facial Pain Unit in London were included in the study. Intensity and pain-related interference were assessed by the Brief Pain Inventory. Pain-related disability was assessed by the Chronic Graded Pain Scale. Average pain intensity (0-10) was classified into nine schemes with varying cutoff points of mild, moderate, and severe pain. The scheme with the most significant intergroup difference, expressed by multivariate analysis of variance, provided the cutoffs between mild, moderate, and severe pain.
  
  
  RESULTS
  The combination that showed the greatest intergroup differences for all patients was scheme 47 (mild 1-4, moderate 5-7, severe 8-10). The same combination provided the greatest intergroup differences in subgroups of patients with temporomandibular disorder and chronic idiopathic facial pain, respectively. Among the trigeminal neuralgia patients alone, the combination with the highest intergroup differences was scheme 48 (mild 1-4, moderate 5-8, severe 9-10).
  
  
  CONCLUSIONS
  The cutoff points established in this study can discriminate in pain intensity categories reasonably well, and showed a significant difference in most of the outcome measures used.
authors.affiliation: Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Vlaho
authors.initials: V
authors.lastname: Brailo
authors.affiliation: Facial Pain Unit, Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, UCLH NHS Foundation Trust/University College London, London, UK.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Zakrzewska
keywords: chronic orofacial pain; cutoff point; temporomandibular disorder; trigeminal neuralgia