University of Oulu

Hietaharju, M., Näpänkangas, R., Sipilä, K., Teerijoki-Oksa, T., Tanner, J., Kemppainen, P., Tolvanen, M., & Suvinen, T. (2021). Importance of the graded chronic pain scale as a biopsychosocial screening instrument in tmd pain patient subtyping. Journal of Oral & Facial Pain and Headache, 303–316.

Importance of the Graded Chronic Pain Scale as a biopsychosocial screening instrument in TMD pain patient subtyping

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Author: Hietaharju, Maria1,2; Näpänkangas, Ritva1,2; Sipilä, Kirsi1,2;
Organizations: 1Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
2Medical Research Center, Oulu, Oulu University Hospital and University of Oulu
3Department of Oral and Maxillofacial diseases, Turku University Hospital, Turku, Finland
4University of Helsinki, Helsinki, Finland
5Helsinki University Hospital, Helsinki, Finland
6University of Oulu, Oulu, Finland
7Institute of Dentistry, University of Turku, Turku, Finland
Format: article
Version: accepted version
Access: embargoed
Persistent link:
Language: English
Published: Quintessence Publishing, 2021
Publish Date: 2022-12-31


Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Series: Journal of oral & facial pain and headache
ISSN: 2333-0384
ISSN-E: 2333-0376
ISSN-L: 2333-0384
Volume: 35
Issue: 4
Pages: 303 - 316
DOI: 10.11607/ofph.2983
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: This study was partly supported by the Finnish Dental Society, Apollonia.
Copyright information: © 2021 Journal of Oral & Facial Pain and Headache. The final authenticated version is available online at