Extrahepatic Burden of Chronic Hepatitis C in Pakistan: A Cross-Sectional Analysis of Pain, Physical Dysfunction and Psychosocial Impairment Across Hepatic Dysfunction Stages

This study is purely observational and does not involve any therapeutic or behavioral intervention. The purpose is to observe and document referred pain patterns in patients diagnosed with Hepatitis C virus (HCV) infection. The condition being observed is Hepatitis C–related referred pain, including musculoskeletal, abdominal, and neuropathic pain presentations that are not anatomically localized to the liver. Pain characteristics, distribution, and severity will be recorded. Participants will undergo: Child-Pugh Score assessment to grade liver disease severity. Numeric Pain Rating Scale (NPRS) to quantify pain intensity. Nordic Body Map (NBM) to document pain location and referred pain distribution patterns. A structured clinical interview documenting pain duration, nature, aggravating/relieving factors, and associated symptoms. Data collection will be carried out by a trained physiotherapist researcher with experience in clinical assessment and pain evaluation. Each participant will undergo a single observational assessment session lasting approximately 20–30 minutes. The overall study observation period will span for 4 months

This study is purely observational and does not involve any therapeutic or behavioral intervention. The purpose is to observe and document referred pain patterns in patients diagnosed with Hepatitis C virus (HCV) infection. The condition being observed is Hepatitis C–related referred pain, including musculoskeletal, abdominal and neuropathic pain presentations that are not anatomically localized to the liver. Pain characteristics, distribution, severity and associated psychosocial factors will be documented. Participants will undergo: Child-Pugh Score assessment to grade liver disease severity. Numeric Pain Rating Scale (NPRS) to quantify pain intensity. Douleur Neuropathique 4 (DN4) questionnaire to screen for neuropathic pain features. Nordic Body Map (NBM) to document pain location and referred pain distribution patterns. Patient Health Questionnaire-9 (PHQ-9) for assessment of depressive symptoms. Generalized Anxiety Disorder-7 (GAD-7) for evaluation of anxiety symptoms. Fatigue Severity Scale (FSS) to assess fatigue severity. Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality disturbances. Structured clinical interview documenting pain duration, nature, aggravating/relieving factors, treatment status, disease duration, comorbidities and associated symptoms. Physical examination including cervical, lumbar and right shoulder range of motion measured using a universal goniometer. Bilateral hand grip strength assessment using a hand dynamometer. Tender point examination to evaluate features suggestive of central sensitization. Recording of available serum ALT and AST values as markers of hepatic inflammation. Data collection will be carried out by a trained physiotherapist researcher experienced in clinical assessment and pain evaluation. Each participant will undergo a single observational assessment session lasting approximately 20–30 minutes. The overall study observation period will span 4 months.