The effect of analgesics on pathological pain in a double-blind, complete cross-over design was assessed by means of two rating scales, a verbal rating scale (VRS) and visual analogue scale (VAS). The VRS is widely used, but has several disadvantages as compared to the VAS. The results obtained by means of the VRS showed higher F-ratios (analysis of variance and Kruskall-Wallis H-test) than those obtained by means of the VAS. The VRS, which transfers a continuous feeling into a digital system, seems to augment artificially the measurement of effects produced by analgesics, and the VAS seems to assess more closely what a patient actually experiences with respect to change in pain intensities. The correlation between the two scales was highly significant (r = 0.81, P less than 0.001). The calculated regression line (y=-29.6 + 0.55-x) was not similar to the line of identity and showed much lower values for the VAS, supporting our interpretation. The distribution of the variances of the values obtained by means of both scales was not homogenous. This indicates that the homogeneity of the distribution of variances should always be checked and a Kruskall-Wallis H-test used, if they are inhomogenously distributed.

Following active periodontal therapy, 41 patients were incorporated in a maintenance program for 2 1/2 years with recall intervals varying between 2-6 months. At the beginning of each maintenance visit, the periodontal tissues were evaluated using "bleeding on probing" (BOP). Reinstrumentation was only performed at sites which bled on probing. However, supragingival plaque and calculus was always removed. Pocket probing depths and probing attachment levels were recorded after active treatment and at the conclusion of the study. Progression of periodontal disease was defined by an observed loss of probing attachment of greater than or equal to 2 mm. The reliability of the BOP test as a predictor was evaluated by calculating sensitivity, specificity, accuracy, and positive and negative predictive values. While only a 29% sensitivity was calculated for frequent bleeding, the specificity was 88%. The fact that the positive predictive value for disease progression was only 6% and the negative predictive value was 98% renders continuous absence of BOP a reliable predictor for the maintenance of periodontal health.

The present study is a follow-up report on the use of bleeding on probing (BOP) as a clinical indicator for disease progression or periodontal stability, respectively. Following active periodontal therapy, 39 patients were incorporated in a program of supportive periodontal therapy for a period of 53 months with recall intervals varying between 2-8 months. The patients received supportive therapy 7 to 14 x. At the beginning of each maintenance visit, the tissues were evaluated using BOP. Reinstrumentation was only performed at sites which bled on probing. However, supragingival plaque and calculus were always removed. Probing depth and probing attachment levels were determined after active treatment and at the conclusion of the study. Progression of periodontal disease was defined by a measured loss of probing attachment of 2 mm or more. During the observation period, 4.2% of all the sites lost attachment. Approximately 50% of these losses were due to periodontal disease progression, while the other half was the result of attachment loss in conjunction with recession of the gingiva. 2/3 of all the sites which lost attachment were found in a group of patients which presented a mean BOP > or = 30%. In a group of patients with a mean BOP of < or = 20%, only 1/5 of the loser sites were found. This clearly indicated, that patients with a mean BOP of < or = 20% have a significantly lower risk for further loss of probing attachment at single sites.

No abstract

Engel's hypothesis of pain-prone patients having a distinct pattern of developmental psychosocial experiences was tested in a controlled design including four groups of 20 patients each: A) psychogenic pain, B) organic pain, C) psychogenic bodily symptoms, and D) organic disease. On admission an open-ended interview, including childhood experiences, was tape-recorded. Measures were taken to minimize observer bias. Patients in group A had, compared to the other groups, significantly increased prevalence of: "Parents, verbally and/or physically abusive of each other," "parents, abusive of the child," "child, deflecting aggression from one parent to the other onto himself," "parents, who suffered from illnesses/pain," "parent of the same gender as the patient suffering from pain," "pain of patient and parent in the same location," "number of operations in adulthood," "disturbance of interpersonal relationships," and "disturbance of work life." Factor analysis produced two factors explaining 73% of the variance in group A: F1 ("Brutality-Overcompensation") was related to "duration of pain," and F2 ("Submission-Inhibition") was related to "number of operations, accidents" in adulthood.