Orthodontic pain trajectories in adolescents: Between-subject and within-subject variability in pain perception
The objective of this study was to assess the effects of age, sex, and the age-sex interaction on mean pain trajectories and individual variations in the pain experienced by adolescents after orthodontic separator placement. We included 115 subjects (mean age, 14.99 years; SD, ±1.90 years; 56 boys,...
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| Veröffentlicht in: | American journal of orthodontics and dentofacial orthopedics Jg. 149; H. 4; S. 491 - 500.e4 |
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| Format: | Journal Article |
| Sprache: | Englisch |
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United States
Elsevier Inc
01.04.2016
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| ISSN: | 0889-5406, 1097-6752, 1097-6752 |
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| Abstract | The objective of this study was to assess the effects of age, sex, and the age-sex interaction on mean pain trajectories and individual variations in the pain experienced by adolescents after orthodontic separator placement.
We included 115 subjects (mean age, 14.99 years; SD, ±1.90 years; 56 boys, 48.7%; 59 girls, 51.3%) in this study. Orthodontic separators were placed in the mesial and distal contact points of the maxillary and mandibular first molars. A 100-mm visual analog scale was used for pain assessment at 11 prespecified times: 1 hour and 2, 4, 12, 24, 36, 48, 72, 96, 120, and 144 hours. A mixed-effects location scale model was used for the data analysis to directly model between-subject and within-subject variabilities in pain in addition to the usual modeling of mean pain as a function of age, sex, and time.
Mean initial pain after 1 hour of separator placement for the 12- to 15-year-old male group was 13.52 mm on the visual analog scale, which initially increased rapidly (linear estimate, 9.16; P = 0.000; 95% confidence interval [CI], −8.65 to 9.67) but decelerated with time (quadratic estimate, −0.95; P = 0.000; 95% CI, −1.0 to −0.90), suggesting an inverted U-shaped mean pain trajectory. Age, sex, and age-sex interaction effects did not significantly influence initial pain. Compared with the 12- to 15-year-old male group, the 15- to 18-year-old female group reported the steepest rise in pain (estimate, 8.55; P = 0.00; 95% CI, 7.40 to 9.70) and, as a result, experienced the most overall pain. The 12- to 15-year-old male group reported minimum between-subjects variations (SD, ±4.6 mm) as well as within-subjects variations (SD, ±5.5 mm). The between-subjects variations were highest for the 12- to 15-year-old female group (SD, ±9.8 mm), whereas the within-subjects variations were highest for the 15- to 18-year-old female group (SD, ±10.1 mm).
The 12- to 15-year-old boys reported the lowest mean average pain intensity and a minimum subjective variation in between-subject and within-subject variances. The 15- to 18-year-old girls experienced maximum mean pain intensity and the highest daily fluctuations in pain intensity. The 12- to 15-year-old girls were the most different from one another in their overall pain experience.
•We examined pain perception among adolescents after orthodontic separator placement.•A novel “mixed-effects location scale model” was used to analyze pain trajectories.•We explored mean scores and subject variability in pain as functions of age and sex.•Subject variability included both between- and within-subject variations in pain.•Age and sex have significant effects on mean scores and subject variability in pain. |
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| AbstractList | Introduction The objective of this study was to assess the effects of age, sex, and the age-sex interaction on mean pain trajectories and individual variations in the pain experienced by adolescents after orthodontic separator placement. Methods We included 115 subjects (mean age, 14.99 years; SD, ±1.90 years; 56 boys, 48.7%; 59 girls, 51.3%) in this study. Orthodontic separators were placed in the mesial and distal contact points of the maxillary and mandibular first molars. A 100-mm visual analog scale was used for pain assessment at 11 prespecified times: 1 hour and 2, 4, 12, 24, 36, 48, 72, 96, 120, and 144 hours. A mixed-effects location scale model was used for the data analysis to directly model between-subject and within-subject variabilities in pain in addition to the usual modeling of mean pain as a function of age, sex, and time. Results Mean initial pain after 1 hour of separator placement for the 12- to 15-year-old male group was 13.52 mm on the visual analog scale, which initially increased rapidly (linear estimate, 9.16; P = 0.000; 95% confidence interval [CI], −8.65 to 9.67) but decelerated with time (quadratic estimate, −0.95; P = 0.000; 95% CI, −1.0 to −0.90), suggesting an inverted U-shaped mean pain trajectory. Age, sex, and age-sex interaction effects did not significantly influence initial pain. Compared with the 12- to 15-year-old male group, the 15- to 18-year-old female group reported the steepest rise in pain (estimate, 8.55; P = 0.00; 95% CI, 7.40 to 9.70) and, as a result, experienced the most overall pain. The 12- to 15-year-old male group reported minimum between-subjects variations (SD, ±4.6 mm) as well as within-subjects variations (SD, ±5.5 mm). The between-subjects variations were highest for the 12- to 15-year-old female group (SD, ±9.8 mm), whereas the within-subjects variations were highest for the 15- to 18-year-old female group (SD, ±10.1 mm). Conclusions The 12- to 15-year-old boys reported the lowest mean average pain intensity and a minimum subjective variation in between-subject and within-subject variances. The 15- to 18-year-old girls experienced maximum mean pain intensity and the highest daily fluctuations in pain intensity. The 12- to 15-year-old girls were the most different from one another in their overall pain experience. The objective of this study was to assess the effects of age, sex, and the age-sex interaction on mean pain trajectories and individual variations in the pain experienced by adolescents after orthodontic separator placement. We included 115 subjects (mean age, 14.99 years; SD, ±1.90 years; 56 boys, 48.7%; 59 girls, 51.3%) in this study. Orthodontic separators were placed in the mesial and distal contact points of the maxillary and mandibular first molars. A 100-mm visual analog scale was used for pain assessment at 11 prespecified times: 1 hour and 2, 4, 12, 24, 36, 48, 72, 96, 120, and 144 hours. A mixed-effects location scale model was used for the data analysis to directly model between-subject and within-subject variabilities in pain in addition to the usual modeling of mean pain as a function of age, sex, and time. Mean initial pain after 1 hour of separator placement for the 12- to 15-year-old male group was 13.52 mm on the visual analog scale, which initially increased rapidly (linear estimate, 9.16; P = 0.000; 95% confidence interval [CI], -8.65 to 9.67) but decelerated with time (quadratic estimate, -0.95; P = 0.000; 95% CI, -1.0 to -0.90), suggesting an inverted U-shaped mean pain trajectory. Age, sex, and age-sex interaction effects did not significantly influence initial pain. Compared with the 12- to 15-year-old male group, the 15- to 18-year-old female group reported the steepest rise in pain (estimate, 8.55; P = 0.00; 95% CI, 7.40 to 9.70) and, as a result, experienced the most overall pain. The 12- to 15-year-old male group reported minimum between-subjects variations (SD, ±4.6 mm) as well as within-subjects variations (SD, ±5.5 mm). The between-subjects variations were highest for the 12- to 15-year-old female group (SD, ±9.8 mm), whereas the within-subjects variations were highest for the 15- to 18-year-old female group (SD, ±10.1 mm). The 12- to 15-year-old boys reported the lowest mean average pain intensity and a minimum subjective variation in between-subject and within-subject variances. The 15- to 18-year-old girls experienced maximum mean pain intensity and the highest daily fluctuations in pain intensity. The 12- to 15-year-old girls were the most different from one another in their overall pain experience. The objective of this study was to assess the effects of age, sex, and the age-sex interaction on mean pain trajectories and individual variations in the pain experienced by adolescents after orthodontic separator placement. We included 115 subjects (mean age, 14.99 years; SD, ±1.90 years; 56 boys, 48.7%; 59 girls, 51.3%) in this study. Orthodontic separators were placed in the mesial and distal contact points of the maxillary and mandibular first molars. A 100-mm visual analog scale was used for pain assessment at 11 prespecified times: 1 hour and 2, 4, 12, 24, 36, 48, 72, 96, 120, and 144 hours. A mixed-effects location scale model was used for the data analysis to directly model between-subject and within-subject variabilities in pain in addition to the usual modeling of mean pain as a function of age, sex, and time. Mean initial pain after 1 hour of separator placement for the 12- to 15-year-old male group was 13.52 mm on the visual analog scale, which initially increased rapidly (linear estimate, 9.16; P = 0.000; 95% confidence interval [CI], −8.65 to 9.67) but decelerated with time (quadratic estimate, −0.95; P = 0.000; 95% CI, −1.0 to −0.90), suggesting an inverted U-shaped mean pain trajectory. Age, sex, and age-sex interaction effects did not significantly influence initial pain. Compared with the 12- to 15-year-old male group, the 15- to 18-year-old female group reported the steepest rise in pain (estimate, 8.55; P = 0.00; 95% CI, 7.40 to 9.70) and, as a result, experienced the most overall pain. The 12- to 15-year-old male group reported minimum between-subjects variations (SD, ±4.6 mm) as well as within-subjects variations (SD, ±5.5 mm). The between-subjects variations were highest for the 12- to 15-year-old female group (SD, ±9.8 mm), whereas the within-subjects variations were highest for the 15- to 18-year-old female group (SD, ±10.1 mm). The 12- to 15-year-old boys reported the lowest mean average pain intensity and a minimum subjective variation in between-subject and within-subject variances. The 15- to 18-year-old girls experienced maximum mean pain intensity and the highest daily fluctuations in pain intensity. The 12- to 15-year-old girls were the most different from one another in their overall pain experience. •We examined pain perception among adolescents after orthodontic separator placement.•A novel “mixed-effects location scale model” was used to analyze pain trajectories.•We explored mean scores and subject variability in pain as functions of age and sex.•Subject variability included both between- and within-subject variations in pain.•Age and sex have significant effects on mean scores and subject variability in pain. The objective of this study was to assess the effects of age, sex, and the age-sex interaction on mean pain trajectories and individual variations in the pain experienced by adolescents after orthodontic separator placement.INTRODUCTIONThe objective of this study was to assess the effects of age, sex, and the age-sex interaction on mean pain trajectories and individual variations in the pain experienced by adolescents after orthodontic separator placement.We included 115 subjects (mean age, 14.99 years; SD, ±1.90 years; 56 boys, 48.7%; 59 girls, 51.3%) in this study. Orthodontic separators were placed in the mesial and distal contact points of the maxillary and mandibular first molars. A 100-mm visual analog scale was used for pain assessment at 11 prespecified times: 1 hour and 2, 4, 12, 24, 36, 48, 72, 96, 120, and 144 hours. A mixed-effects location scale model was used for the data analysis to directly model between-subject and within-subject variabilities in pain in addition to the usual modeling of mean pain as a function of age, sex, and time.METHODSWe included 115 subjects (mean age, 14.99 years; SD, ±1.90 years; 56 boys, 48.7%; 59 girls, 51.3%) in this study. Orthodontic separators were placed in the mesial and distal contact points of the maxillary and mandibular first molars. A 100-mm visual analog scale was used for pain assessment at 11 prespecified times: 1 hour and 2, 4, 12, 24, 36, 48, 72, 96, 120, and 144 hours. A mixed-effects location scale model was used for the data analysis to directly model between-subject and within-subject variabilities in pain in addition to the usual modeling of mean pain as a function of age, sex, and time.Mean initial pain after 1 hour of separator placement for the 12- to 15-year-old male group was 13.52 mm on the visual analog scale, which initially increased rapidly (linear estimate, 9.16; P = 0.000; 95% confidence interval [CI], -8.65 to 9.67) but decelerated with time (quadratic estimate, -0.95; P = 0.000; 95% CI, -1.0 to -0.90), suggesting an inverted U-shaped mean pain trajectory. Age, sex, and age-sex interaction effects did not significantly influence initial pain. Compared with the 12- to 15-year-old male group, the 15- to 18-year-old female group reported the steepest rise in pain (estimate, 8.55; P = 0.00; 95% CI, 7.40 to 9.70) and, as a result, experienced the most overall pain. The 12- to 15-year-old male group reported minimum between-subjects variations (SD, ±4.6 mm) as well as within-subjects variations (SD, ±5.5 mm). The between-subjects variations were highest for the 12- to 15-year-old female group (SD, ±9.8 mm), whereas the within-subjects variations were highest for the 15- to 18-year-old female group (SD, ±10.1 mm).RESULTSMean initial pain after 1 hour of separator placement for the 12- to 15-year-old male group was 13.52 mm on the visual analog scale, which initially increased rapidly (linear estimate, 9.16; P = 0.000; 95% confidence interval [CI], -8.65 to 9.67) but decelerated with time (quadratic estimate, -0.95; P = 0.000; 95% CI, -1.0 to -0.90), suggesting an inverted U-shaped mean pain trajectory. Age, sex, and age-sex interaction effects did not significantly influence initial pain. Compared with the 12- to 15-year-old male group, the 15- to 18-year-old female group reported the steepest rise in pain (estimate, 8.55; P = 0.00; 95% CI, 7.40 to 9.70) and, as a result, experienced the most overall pain. The 12- to 15-year-old male group reported minimum between-subjects variations (SD, ±4.6 mm) as well as within-subjects variations (SD, ±5.5 mm). The between-subjects variations were highest for the 12- to 15-year-old female group (SD, ±9.8 mm), whereas the within-subjects variations were highest for the 15- to 18-year-old female group (SD, ±10.1 mm).The 12- to 15-year-old boys reported the lowest mean average pain intensity and a minimum subjective variation in between-subject and within-subject variances. The 15- to 18-year-old girls experienced maximum mean pain intensity and the highest daily fluctuations in pain intensity. The 12- to 15-year-old girls were the most different from one another in their overall pain experience.CONCLUSIONSThe 12- to 15-year-old boys reported the lowest mean average pain intensity and a minimum subjective variation in between-subject and within-subject variances. The 15- to 18-year-old girls experienced maximum mean pain intensity and the highest daily fluctuations in pain intensity. The 12- to 15-year-old girls were the most different from one another in their overall pain experience. |
| Author | Leckie, George Sandhu, Satpal S. |
| Author_xml | – sequence: 1 givenname: Satpal S. surname: Sandhu fullname: Sandhu, Satpal S. email: drsatpalsandhu@yahoo.co.in organization: Professor, Department of Orthodontics and Dentofacial Orthopedics, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India – sequence: 2 givenname: George surname: Leckie fullname: Leckie, George organization: Senior lecturer in Social Statistics, Centre for Multilevel Modelling, Graduate School of Education, University of Bristol, Bristol, United Kingdom |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27021453$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_21307_aoj_2020_114 crossref_primary_10_1038_s41598_024_56363_0 crossref_primary_10_1080_14653125_2016_1275442 crossref_primary_10_1093_ejo_cjw088 crossref_primary_10_1097_j_pain_0000000000001626 crossref_primary_10_1177_14653125221144059 crossref_primary_10_1016_j_ajodo_2025_02_018 crossref_primary_10_1016_j_sdentj_2024_04_010 crossref_primary_10_1186_s12903_023_03565_z crossref_primary_10_3389_fneur_2025_1547095 crossref_primary_10_1053_j_sodo_2018_04_003 crossref_primary_10_1080_27705781_2022_2096185 crossref_primary_10_1007_s00784_023_04931_5 crossref_primary_10_1177_13591053241235751 |
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| Copyright | 2016 American Association of Orthodontists American Association of Orthodontists Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved. |
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| SubjectTerms | Adolescent Age Factors Analgesics - therapeutic use Child Circadian Rhythm Dentistry Female Follow-Up Studies Humans Male Molar - physiopathology Orthodontic Appliances Pain Measurement - methods Pain Perception - physiology Sex Factors Stress, Mechanical Tooth Movement Techniques - instrumentation |
| Title | Orthodontic pain trajectories in adolescents: Between-subject and within-subject variability in pain perception |
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