Graded Chronic Pain Scale (GCPS) 1. How would you rate your facial pain on a 0 to 10 scale at the present time, that is right now, where 0 is no pain and 10 is pain as bad as could be? No pain Pain as bad as could be 0 1 2 3 4 5 6 7 8 9 10 2. In the past six months, how intense was your worst pain, rated on a 0 to 10 scale where 0 is no pain and 10 is pain as bad as could be? No pain Pain as bad as could be 0 1 2 3 4 5 6 7 8 9 10 3. In the past six months, on the average, how intense was your pain rated on a 0-10 scale where 0 is no pain and 10 is pain as bad as could be? (That is you usual pain at times you were experiencing pain).) No pain Pain as bad as could be 0 1 2 3 4 5 6 7 8 9 10 4. In the past six months, how much has facial pain interfered with your daily activities rated on a 0 to 10 scale where 0 is no interference and 10 is unable to carry on any activities? No interference Unable to carry on any activities 0 1 2 3 4 5 6 7 8 9 10 5. In the past six months, how much has facial pain changed your ability to take part in recreational, social and family activities where 0 is no change and 10 is extreme change? No change Extreme change 0 1 2 3 4 5 6 7 8 9 10 6. In the past six months, how much has facial pain changed your ability to work (including housework) where 0 is no change and 10 is extreme change? No change Extreme change 0 1 2 3 4 5 6 7 8 9 10 7. About how many days in the last six months have you been kept from your usual activities (work, school or housework) because of facial pain? _____________ Days

Scoring Criteria for Grading Chronic Pain Severity Characteristic Pain Intensity is a 0 to 100 score derived from Questions 1 through 3: Mean (Pain Right Now, Worst Pain, Average Pain) X 10 Disability Score is 0 to 100 score derived from Questions 4 through 6: Mean (Daily Activities, Social Activities, Work Activities) X 10 Disability Points: Add the indicated points for Disability Days (Question 7) and for Disability Score.

Disability Points Disability Days (0-180 Days) Disability Score (0-100) 0-6 Days 0 Points 0-29 0 Points 7-14 Days 1 Point 30-49 1 Point 15-30 Days 2 Points 50-69 2 Points 31+ Days 3 Points 70+ 3 Points Classification Grade 0 No TMD pain in prior 6 months Grade 1 Low Intensity Characteristic Pain Intensity< 50 Low Disability < 3 Disability Point Grade II High Intensity Characteristic Pain Intensity > 50 Low Disability < 3 Disability Points Grade III High Disability 3 to 4 Disability Points Moderately Limiting (Regardless of Characteristic Pain Intensity)

Grade IV High Disability 5 to 6 Disability Points Severely Limiting (Regardless of Characteristic Pain Intensity) Von Korff M, Ormel J, Keefe FJ et al. Grading the severity of chronic pain.

Pain 1992; 50:133-149.