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Full-Text Articles in Psychology

Everyone Deserves A Dental Home, Loren C. Baim Dds Apr 2024

Everyone Deserves A Dental Home, Loren C. Baim Dds

The New York State Dental Journal

With knowledge and preparation, dental practices should be able to accommodate the growing population of people on the autism spectrum.


The Role Of Oral Microbiota In Periodontitis And Alzheimer's Disease, Noah Al-Hassan, Taha Al Hassan, Juan C. Lopez-Alvarenga, Maria Quinones, Seratna Guadarrama Mar 2024

The Role Of Oral Microbiota In Periodontitis And Alzheimer's Disease, Noah Al-Hassan, Taha Al Hassan, Juan C. Lopez-Alvarenga, Maria Quinones, Seratna Guadarrama

Research Symposium

Background: Periodontal disease (PD), affecting 20-50% of the global population is marked by biofilm-induced inflammation in oral tissues. Chronic PD results in systemic complications such as heart disease, stroke, and Alzheimer's. The red complex microbes, Porphyromonas gingivalis and Treponema denticola, play a pivotal role, penetrating the blood-brain barrier and contributing to neurodegeneration. Alzheimer's disease (AD), an irreversible neurodegenerative disorder, is linked to abnormal protein cleavage and potentially involves microbiologic components, including gram-positive cocci. Research suggests the presence of bacteria such as Porphyromonas, Actinomyces, and Treponema in autopsied AD brains. Investigating the microbiologic connection between PD and AD is crucial, considering …


Evaluating The Oral Health-Related Quality Of Life Among Dental Patients In South India - A Descriptive Study, Dheekshitha P K, Sudeep C B Dr., Sunil P M Dr., Suji M Dr. Feb 2024

Evaluating The Oral Health-Related Quality Of Life Among Dental Patients In South India - A Descriptive Study, Dheekshitha P K, Sudeep C B Dr., Sunil P M Dr., Suji M Dr.

Annual Research Symposium

This study aims to evaluate the oral health-related quality of life among dental patients in South India.


A Study Protocol Testing Pre-Exposure Dose And Compound Pre-Exposure On The Mechanisms Of Latent Inhibition Of Dental Fear, Andrew L. Geers, Laura D. Seligman, Keenan A. Pituch, Ben Colagiuri, Hilary A. Marusak, Christine A. Rabinak, Natalie Turner, Sena L. Al-Ado, Michael Nedley Jan 2024

A Study Protocol Testing Pre-Exposure Dose And Compound Pre-Exposure On The Mechanisms Of Latent Inhibition Of Dental Fear, Andrew L. Geers, Laura D. Seligman, Keenan A. Pituch, Ben Colagiuri, Hilary A. Marusak, Christine A. Rabinak, Natalie Turner, Sena L. Al-Ado, Michael Nedley

Psychological Science Faculty Publications and Presentations

Background: Dental stimuli can evoke fear after being paired - or conditioned - with aversive outcomes (e.g., pain). Pre-exposing the stimuli before conditioning can impair dental fear learning via a phenomenon known as latent inhibition. Theory suggests changes in expected relevance and attention are two mechanisms responsible for latent inhibition. In the proposed research, we test whether pre-exposure dose and degree of pre-exposure novelty potentiate changes in expected relevance and attention to a pre-exposed stimulus. We also assess if the manipulations alter latent inhibition and explore the possible moderating role of individual differences in pain sensitivity.

Methods: Participants will be …


Be A Leader In Your Practice: What’S Your Style?, William Chase Dds, Maom Dec 2023

Be A Leader In Your Practice: What’S Your Style?, William Chase Dds, Maom

The Journal of the Michigan Dental Association

In this Leadership Development feature, the author draws from a wealth of leadership experience in Rotary to explore the importance of leadership in dentistry. Emphasizing the need for self-evaluation through emotional intelligence, the article delves into five key aspects: self-awareness, self-regulation, motivation, empathy, and social skills. The author introduces three leadership styles — Transformational Leadership, Situational Leadership, and Servant Leadership — highlighting their characteristics and benefits. Encouraging readers to adopt diverse leadership styles, the piece underlines the significance of effective leadership in dental practice, community engagement, and organized dentistry.


The Prevalence Of Burnout In Saudi Arabia Dental Hygienists, Nouf Hamad Aldayel Oct 2023

The Prevalence Of Burnout In Saudi Arabia Dental Hygienists, Nouf Hamad Aldayel

Dental Hygiene Theses & Dissertations

Purpose: The purpose of this pilot study was to assess the prevalence of burnout in Saudi Arabian dental hygienists and identify risk factors associated with burnout. Methods: A descriptive survey design using the Copenhagen Burnout Inventory (CBI) assessed burnout among a convenience sample of n=123 Saudi dental hygienists. The survey was disseminated electronically to 1,000 Saudi Arabian dental hygienists. The CBI measures three subscales: personal, work-related, and client/patient-related burnout on a five-point Likert-type scale. The survey also included six demographic questions, two Likert-type, one “yes/no,” and one openended question, related to burnout. Descriptive statistics, one-way between subject’s ANOVA, independent samples …


Dental Care Utilization Among U.S. Children Participating In Early Head Start Programs, Ahlam Ibraheem Joufi Aug 2023

Dental Care Utilization Among U.S. Children Participating In Early Head Start Programs, Ahlam Ibraheem Joufi

Health Services Research Dissertations

Early childhood caries (ECC) remains one of the most common preventable diseases among children under the age of 6 years. Several national stakeholders recommend establishing a continuous collaboration of individuals involved with receiving oral health services (dental home) and routine dental care for the child by 12 months. Despite this recommendation, disparities exist among young, low-income children in preventive dental service utilization. The Early Head Start (EHS) program serves low-income children aged 0-3 years and their families and promotes oral health practices and service utilization within the program. This study aims to examine predictors of dental care utilization among children …


Compassion: It’S Needed Now More Than Ever, Michelle C. Dziurgot Dds Aug 2023

Compassion: It’S Needed Now More Than Ever, Michelle C. Dziurgot Dds

The Journal of the Michigan Dental Association

This editorial emphasizes the pressing need for compassion in a world of conflict and division. It underscores the importance of compassion in global crises, politics, family dynamics, and the dental profession. MDA Editor Michelle C. Dziurgot encourages unity and understanding, advocating for compassion as a vital force in bridging divides.


Dental Fear, Anxiety, And Phobia – Behavioral Management And Implications For Dentists, Nadya Tsetsova Avramova Apr 2023

Dental Fear, Anxiety, And Phobia – Behavioral Management And Implications For Dentists, Nadya Tsetsova Avramova

Journal of Mind and Medical Sciences

Clinical management of patients with dental fear, anxiety, and phobia could be a major challenge to daily practice of dental professionals. The aim of the current review was to expand the modern consideration with respect to these issues, and therefore to discuss basic approaches and psychological techniques for management of oral health behaviors that should be employed in dentistry. This paper presents detailed description of the characteristics of dentist-patient therapeutic relationship as well as the most used techniques to cope with dental fear, anxiety, and phobia - relaxation techniques, cognitive-behavioral therapy (CBT), hypnosis and melotherapy. We can still argue that …


Bullied Because Of Their Teeth: Evidence From A Longitudinal Study On The Impact Of Oral Health On Bullying Victimization Among Australian Indigenous Children, Md Irteja Islam, Verity Chadwick, Tuguy Esgin, Alexandra Martiniuk May 2022

Bullied Because Of Their Teeth: Evidence From A Longitudinal Study On The Impact Of Oral Health On Bullying Victimization Among Australian Indigenous Children, Md Irteja Islam, Verity Chadwick, Tuguy Esgin, Alexandra Martiniuk

Research outputs 2022 to 2026

Making life better for Indigenous peoples is a global priority. Although bullying and oral health have always been a topic of concern, there is limited information regarding the impact of this problem on the general population, with no evidence in this regard among the Australian Indigenous population. Thus, we aimed to quantify the relationship between bullying victimization and oral health problems by remoteness among 766 Australian Indigenous children aged between 10–15-years using data from the LSIC study. Bivariate and multilevel mixed-effect logistic regression analyses were employed. Findings indicated children self-reported bullying more than parents reported their children were being bullied …


Developing A Dental Trauma-Anxiety Measure Comparing U.S. And International Care, Margaret Tajirian Mar 2022

Developing A Dental Trauma-Anxiety Measure Comparing U.S. And International Care, Margaret Tajirian

Seaver College Research And Scholarly Achievement Symposium

Background

The aim of this study was to improve upon the Modified Dental Anxiety Scale (MDAS) by developing the empathy-based International-Modified Dental Anxiety Scale (I-MDAS). This measure was produced and utilized to compare the dental experiences and anxiety levels of international patients versus national patients in the United States.

Methods

The I-MDAS is composed of the International scale and the original MDAS scale. Of 465 participants, 41.3% comprised the national population and 58.7% comprised the international population. Information about demographics, past negative dental experiences, and current dental anxiety was collected.

Results

There was no significant difference in dental anxiety levels …


Zonulin As A Mediator Of Psychological Stress And Periodontal Disease, Casey D. Wright Jan 2022

Zonulin As A Mediator Of Psychological Stress And Periodontal Disease, Casey D. Wright

Graduate Theses, Dissertations, and Problem Reports

The prevalence of chronic inflammatory diseases is on the rise. Some have posited the permeability of tight junctions in gastrointestinal epithelium tissues as a potential mechanism for precipitating inflammatory processes throughout the body. Zonulin is the only known modulator of tight junction permeability and has been implicated in numerous chronic inflammatory processes (e.g., proinflammatory cytokine production) and diseases, more generally. The role of zonulin in oral inflammation, however, has yet to be explored. Periodontal disease is the most common oral inflammatory condition and primary perpetrator of tooth loss. Periodontal disease also is associated with a number of other health problems …


The Effects Of Covid-19-Related Stressors On Bruxism And Temporomandibular Disorders, Hagir A. Saleh, Samantha Smith Jan 2021

The Effects Of Covid-19-Related Stressors On Bruxism And Temporomandibular Disorders, Hagir A. Saleh, Samantha Smith

Dental Hygiene Student Scholarship

Problem: COVID-19 has proven to be a major public health emergency, with an array of physical and emotional complications. While COVID-19 has its own effects on the human body, anxiety induced by the pandemic has shown to take a toll on the human oral cavity by means of causing individuals to grind and clench their teeth due to anxiety/stress, potentially leading to temporomandibular disorders and orofacial pain.

Methods: A thorough review of literature was conducted by consulting credible studies published on online databases such as PubMed, Dentistry & Oral Sciences Source, Google Scholar, and Academic Search Complete. The studies examined …


Using Eye Tracking To Explore Visual Attention In Adolescents With Autism Spectrum Disorder, Anne M.P. Michalek, Jonna Bobzien, Victor A. Lugo, Chung Hao Chen, Ann Bruhn, Michail Giannakos Jan 2021

Using Eye Tracking To Explore Visual Attention In Adolescents With Autism Spectrum Disorder, Anne M.P. Michalek, Jonna Bobzien, Victor A. Lugo, Chung Hao Chen, Ann Bruhn, Michail Giannakos

Communication Disorders & Special Education Faculty Publications

Video social stories are used to facilitate understanding of social situations for adolescents with autism spectrum disorder (ASD). This study explored the use of eye tracking technology to understand how adolescents with and without ASD visually attend to video social story content and whether visual attention is related to content comprehension. Six adolescents, with and without ASD, viewed a video social story of visiting a dental office. Eye gaze metrics, including fixation duration and count, and visit duration were collected to measure visual attention, and a knowledge assessment was administered for comprehension. Results indicated adolescents with ASD fixated and maintained …


The Prevalence Of Burnout Among Entry-Level Dental Hygiene Program Directors, Jessica Suedbeck, Emily A. Ludwig, Susan Lynn Tolle Jan 2021

The Prevalence Of Burnout Among Entry-Level Dental Hygiene Program Directors, Jessica Suedbeck, Emily A. Ludwig, Susan Lynn Tolle

Dental Hygiene Faculty Publications

Purpose: Workplace burnout in academia is a problem that affects career satisfaction and longevity. The purpose of this study was to determine the prevalence of burnout among entry-level dental hygiene program directors.

Methods: The Copenhagen Burnout Inventory (CBI) survey was used to determine prevalence of burnout in 325 dental hygiene program directors from across the United States. The survey was disseminated electronically. The CBI contains 19 questions that measure overall, personal, work-related, and client/student-related burnout on a five-point Likert type scale. The survey also included nine demographic and three open-ended questions related to burnout. Descriptive statistics, one sample t-tests, and …


A Case Study Of Barriers To Dental Care In Nebraska, Kaitlin Buhler Mar 2020

A Case Study Of Barriers To Dental Care In Nebraska, Kaitlin Buhler

Honors Theses

An important aspect of overall health is access to dental care, which is, unfortunately, oftentimes difficult to obtain. This study used data collected from a case study of three registered dentists in Nebraska to investigate the barriers to dental care, and identified the lack of dental insurance, limited access to free or reduced-price dental care, and dental anxiety as perceived barriers to dental care. Factors that did not seem to have an impact were language or ethnicity differences between patients and workers, distance to travel, comfortability with receiving free or reduced-price dental care, knowledge of how often to visit the …


Does Common-Sense Communication And The Interpersonal Relationship Predict Oral Health Self-Management?, Kieran J. Maestro Jan 2020

Does Common-Sense Communication And The Interpersonal Relationship Predict Oral Health Self-Management?, Kieran J. Maestro

Legacy Theses & Dissertations (2009 - 2024)

This study sought to understand how patients’ perceptions of the nature and manner of communication with dental health professionals may impact their health self-management quality and habits in the context of preventable illness. Specifically, this study investigated the distinct and overlapping impacts of (a) communication based in the Common Sense Self-Regulation Model (CSM; Leventhal et al., 1980), and (b) the interpersonal relationship between the patient and the dental health professional provider on patients’ oral hygiene quality and habits. It was hypothesized that the interpersonal relationship would positively moderate a positive relation between CSM-based communication and patients' oral health self-management and …


Workplace Bullying: A National Survey Of Dental Hygienists, Savannah Dawn Sundburg Oct 2019

Workplace Bullying: A National Survey Of Dental Hygienists, Savannah Dawn Sundburg

Dental Hygiene Theses & Dissertations

Problem: Workplace bullying in health care affects career satisfaction, career longevity and patient outcomes. The purpose of this study was to determine if bullying was occurring in dental hygiene employment settings as well as its prevalence in a convenience sample of dental hygienists.

Methods: After IRB approval, 1200 subscribers to a professional dental hygiene journal were invited to participate. Employing the validated Negative Acts Questionnaire-Revised (NAQ-R), participants were asked to indicate how often they experienced 22 defined negative behaviors according to rate of occurrence (never, now and then or monthly, weekly or daily) over the past six months. Bullying was …


The Impact Of Cleft Lip/Palate And Clp Surgical Intervention On The Social Integration Of Adolescents In India, Mustafa Zahid May 2019

The Impact Of Cleft Lip/Palate And Clp Surgical Intervention On The Social Integration Of Adolescents In India, Mustafa Zahid

Master's Theses

Cleft Lip/Palate, a congenital orofacial anomaly, carries an incidence rate of approximately 1 in every 1000 births. In addition to the stigma associated with the condition, the varying levels of cleft severity might result in lower life outcomes which could include lower cognitive ability, physical and psychological well-being, social and behavioral outcomes of adolescents. This paper focuses on the social integration element of life outcomes, which is composed of the social inclusion and prosocial behavior of the adolescent. Despite the affordability of restorative surgeries, patients in rural areas of Low and Middle-Income Countries (LMICs) such as India face accessibility and …


Diversity In Parenting: A Qualitative Study On The Socialization Goals Of Palestinian Mothers From Different Socio-Economic Backgrounds, Layali Ba Hamayel Jun 2018

Diversity In Parenting: A Qualitative Study On The Socialization Goals Of Palestinian Mothers From Different Socio-Economic Backgrounds, Layali Ba Hamayel

Theses and Dissertations

This study examined diversity in the socialization goals (SGs) of Palestinian mothers from different educational and socioeconomic backgrounds. It specifically looked at their cultural model using the Family Change model to analyze elements of collectivism and individualism in their attitudes and goals for the future. Purposeful-convenience sampling was used to recruit twelve urban Arab mothers of first grade children from two types of socio-economic backgrounds (SES). Each mother was interviewed about her goals and asked to describe her child. The interviews were analyzed thematically, and coding was guided by that used by other studies on SGs. One main finding was …


Assessment Of Pain-Related Fear In Individuals With Chronic Painful Conditions, Manasi M. Mittinty, Daniel W. Mcneil, David S. Brennan, Cameron L. Randall, Murthy N. Mittinty, Lisa Jamieson Jan 2018

Assessment Of Pain-Related Fear In Individuals With Chronic Painful Conditions, Manasi M. Mittinty, Daniel W. Mcneil, David S. Brennan, Cameron L. Randall, Murthy N. Mittinty, Lisa Jamieson

Faculty & Staff Scholarship

Background: Heightened fear and anxiety related to pain may result in emotional and behavioral avoidance responses causing disability, distress, and depression. Fear and anxiety associated with pain can potentially change the course of the pain experience. It is plausible that fear and anxiety related to pain affect the duration and frequency of pain experienced by the patient. Aim: The study aimed to examine the applicability of the Fear of Pain Questionnaire-III (FPQ-III) in identifying who are likely to report longer duration and greater frequency of pain experience. Methods: To test this hypothesis, a cross-sectional study was conducted with 579 individuals …


Perceptions And Attitudes Of Healthcare Students Towards Marijuana, Carrie Crosby Jan 2018

Perceptions And Attitudes Of Healthcare Students Towards Marijuana, Carrie Crosby

EWU Masters Thesis Collection

Perceptions of marijuana were studied in healthcare students at EWU. It was found that most students had an average self-reported knowledge of marijuana use. Marijuana comes in several forms such as, edibles, smoked, patches, and lotions. With its recent legalization in Washington State, sales tax alone has accumulated $400 million dollars in the past 3 years. With this increase in use an examination of healthcare students was warranted. Most students also felt there was a need for more education on marijuana and that their current knowledge level was not enough to be competent when talking with patients about use. Overall, …


Cumulative Trauma, Emotion Reactivity And Salivary Cytokine Response Following Acute Stress Among Healthy Women., Yvette Z. Szabo Aug 2017

Cumulative Trauma, Emotion Reactivity And Salivary Cytokine Response Following Acute Stress Among Healthy Women., Yvette Z. Szabo

Electronic Theses and Dissertations

This study furthers understanding of how trauma exposure may be connected to the development and maintenance of poor health by focusing on cytokines, tightly regulated proteins of the immune system. Cytokine responses to acute stress have been associated with the onset of poorer mental health in physically healthy women. The present study examined how two factors recently associated with cytokine reactivity –cumulative trauma and emotion reactivity– are associated with salivary cytokine reactivity among healthy women. Seventy-one women, screened to be physically and mentally healthy, completed a laboratory acute stress paradigm and self-report measures of state emotion and trauma exposure. Participants …


The Implementation Of Alternative Pain Control Methods By Dental Hygienists, Alejandra Valadez Rodriguez Sep 2016

The Implementation Of Alternative Pain Control Methods By Dental Hygienists, Alejandra Valadez Rodriguez

Mahurin Honors College Capstone Experience/Thesis Projects

As a dental hygienist, it is important to understand new concepts and techniques that can contribute to a more comfortable setting for patients who experience dental anxiety. Alternative pain control methods can assist in alleviating patient anxiety, therefore, providing a more efficient and relaxed clinical atmosphere for both patient and clinician. Some of the methods discussed are: guided imagery, deep breathing, muscle relaxation, hypnosis, acupressure, essential oil diffusion, audio distraction, and visual stimuli. After reviewing the literature the researcher found that dental anxiety affects patient compliance, their overall health, and willingness to attend regular dental visits. The purpose of this …


Animal Assisted Therapy In A Special Needs Dental Practice: An Interprofessional Model For Anxiety Reduction, Caren M. Cajares, Carolyn M. Rutledge, Tina S. Haney Jan 2016

Animal Assisted Therapy In A Special Needs Dental Practice: An Interprofessional Model For Anxiety Reduction, Caren M. Cajares, Carolyn M. Rutledge, Tina S. Haney

Nursing Faculty Publications

Purpose: Individuals with intellectual and developmental disabilities (IDD) suffer from poor oral hygiene and periodontal disease that may predispose them to systemic diseases. In order to receive dental care, the assistance of a certified registered nurse anesthetist (CRNA) is often needed. The role of the CRNA is to provide sedation to reduce the high level of anxiety demonstrated by many individuals with intellectual disabilities in the dental suite. However, this can become a challenge with patients that are anxious when they arrive. The purpose of this paper is to describe an interprofessional dental team that added a certified therapy dog …


Barriers To Membership In The American Dental Hygienists’ Association In The State Of Georgia, Brandy Henderson Dec 2013

Barriers To Membership In The American Dental Hygienists’ Association In The State Of Georgia, Brandy Henderson

Electronic Theses and Dissertations

Professional associations must have a significant level of membership to be effective. Georgia membership is increasingly low; therefore, ADHA cannot represent dental hygienists’ interests. This study determined factors that caused dental hygienists to continue to forgo membership in the ADHA. Several theoretical views of professional membership were considered. The sample was acquired from an unbiased systematic sampling of 50% (3,270) of registered dental hygienists and a convenience sampling of ADHA nonmembers at 2 continuing education seminars in Georgia. Data collection procedures included an electronic cover letter, consent form, and survey via Survey Monkey or hard copies for seminars. Three hundred …


Combatting Dental Anxiety In Patients, Gretchen Osdoba Apr 2013

Combatting Dental Anxiety In Patients, Gretchen Osdoba

Natural Science Student Work

Dental Anxiety is a highly debilitating condition that can keep people away from the dentist and from receiving critical care. This can lead to serious medical conditions that could have easily been prevented through proper dental care. The purpose of this paper is to describe the nature of dental fear and the different treatment options available. I will focus on helpful traits of dentists and the use of psychological treatments, nitrous oxide, anti-anxiety medications, and general anesthesia to reduce this fear. I will also discuss a comparison of a psychological treatment and an anti-anxiety medication as short-term and long-term treatment …


Handbook On Sensitive Practice For Health Care Practitioners: Lessons From Adult Survivors Of Childhood Sexual Abuse, Candice L. Schachter, Carol Stalker, Eli Teram, Gerri C. Lasiuk, Alanna Danilkewich Jan 2009

Handbook On Sensitive Practice For Health Care Practitioners: Lessons From Adult Survivors Of Childhood Sexual Abuse, Candice L. Schachter, Carol Stalker, Eli Teram, Gerri C. Lasiuk, Alanna Danilkewich

Lyle S. Hallman Social Work Faculty Publications

This handbook is the culmination of a multiphase, multidisciplinary research project that used grounded theory and participatory action research to illuminate ways that healthcare providers can work sensitively (in a trauma-informed way) with adult survivors of childhood sexual abuse.

The research identified nine Principles of Sensitive Practice: respect, rapport, taking time, sharing information and control, respecting boundaries, fostering mutual learning, understanding non-linear healing and demonstrating an understanding of trauma to patients. Specific guidelines were developed for a wide variety of issues pertinent to clinical practice such as, removal of clothing, touch, responding to disclosures of abuse, managing triggers among others. …


Training Program To Improve Estimation Of Patients' Periodontal Pain Experience, Yoon Jeong Kim May 2006

Training Program To Improve Estimation Of Patients' Periodontal Pain Experience, Yoon Jeong Kim

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The purpose of this study was to determine if periodontal residents could enhance their ability to appraise the pain levels experienced by their patients from probing, using Visual Analog Scale (VAS) to record pain. We hypothesized that with increasing experience by repeated comparisons of the patients' VAS pain ratings with independent ratings by the residents, they would improve their ability to appraise their patients' pain experiences.

Methods: For each of three periodontal residents, 40 consecutive periodontitis patients were asked to express the degree of pain they experienced during the probing. Independently, the residents rated the pain level they perceived …


Pain Experienced By Patients Using Thinner Vs. Thicker Probes During Probing, Mohamed A. Hassan Jun 2004

Pain Experienced By Patients Using Thinner Vs. Thicker Probes During Probing, Mohamed A. Hassan

Loma Linda University Electronic Theses, Dissertations & Projects

The aim of the present study, performed during periodontal recall visits, was to compare the levels of pain experienced by patients during periodontal probing using probes with tip diameters of either 0.40 mm or 0.63 mm.

Prior to the maintenance procedures, three groups of 20 adult patients were examined by 3 different therapists. Diagonal maxillary/mandibular quadrants were probed with a 0.40 mm and a 0.63 mm probe, respectively. At the completion of probing of each quadrant, the patients were asked to describe their pain using a Visual Analog Scale (VAS).

The results were as follows: Most patients showed low VAS …