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WWW.spinepaindocs.com Spine & Pain Institute of New England Comprehensive Pain Questionnaire Name: Today's Date: / / What is your main pain concern? Indicate on the diagram below where your pain is

How to fill out comprehensive pain questionnaire

How to fill out a comprehensive pain questionnaire?

1. Start by carefully reading the instructions provided with the questionnaire. This will guide you on how to properly answer each question and provide relevant information.
2. Begin by entering your personal information, such as your name, age, gender, and contact details. This helps in identifying and tracking your responses.
3. The questionnaire may ask about the location of the pain. Provide specific details like whether it's localized or radiating, the intensity of the pain, and any factors that worsen or alleviate it.
4. Describe the onset and duration of the pain. Mention when it first started, if it has been constant, intermittent, or has varying patterns over time.
5. Record any previous treatments or interventions you've undergone to manage the pain. This can include medications, therapies, surgeries, or alternative treatments.
6. Provide information about your medical history, including any pre-existing conditions or chronic illnesses that might be relevant to your pain experience. This helps healthcare professionals identify potential underlying causes.
7. The questionnaire may inquire about your lifestyle and daily activities. Be honest and comprehensive, as certain habits or movements could contribute to or exacerbate your pain.
8. Consider any emotional or psychological factors that could be associated with your pain. Stress, anxiety, depression, or past traumas may influence your pain experience and should be noted.
9. Fill out the questionnaire in as much detail as possible, ensuring you respond to every question accurately. If there is not enough space, attach additional sheets if allowed, or mention that you have more information to share.
10. Once completed, review your answers and make sure all necessary information has been provided. If you have any questions or concerns about certain questions, seek clarification from a healthcare professional or the person responsible for the questionnaire.

Who needs a comprehensive pain questionnaire?

1. Individuals experiencing chronic or persistent pain that impacts their daily lives.
2. Patients seeking medical or therapeutic interventions for their pain management.
3. Healthcare providers or researchers looking to gather detailed information regarding a patient's pain experience to inform treatment plans or further investigations.

People Also Ask about

How is the pain questionnaire scored?

In a Numerical Rating Scale (NRS), patients are asked to circle the number between 0 and 10, 0 and 20 or 0 and 100 that fits best to their pain intensity [1]. Zero usually represents 'no pain at all' whereas the upper limit represents 'the worst pain ever possible'.

What questions should you ask as part of your pain assessment?

Where do you have pain/are you sore/ aching or hurting? Can you describe how it feels? (e.g. numb, electric, pinching, shooting, tingling, ache, etc.) How long have you been in pain/aching/ hurting? Does pain/aching ever keep you from sleeping at night?

What questioning do you fill in the pain assessment form?

Where are you feeling pain? When did the pain start? How long have you been in pain? Is the pain constant or intermittent?

What is the most common pain questionnaire?

The McGill Pain Questionnaire, also known as the McGill Pain Index, consists of 78 words that describe pain.

What should a comprehensive pain assessment include?

A comprehensive pain assessment includes a detailed health history, physical exam, psychosocial assessment, medication history (including nonprescription drug use and complementary and alternative therapies), and assessment of functional status.

How do you complete a pain assessment?

PQRST Pain Assessment Method P = Provocation/Palliation. What were you doing when the pain started? Q = Quality/Quantity. What does it feel like? R = Region/Radiation. Where is the pain located? S = Severity Scale. T = Timing. Documentation.

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What is comprehensive pain questionnaire?

Comprehensive pain questionnaire is a detailed form used to gather information about a patient's pain, including the type, intensity, location, and any associated symptoms.

Who is required to file comprehensive pain questionnaire?

Healthcare professionals, such as doctors and nurses, are usually required to administer and file comprehensive pain questionnaires for their patients.

How to fill out comprehensive pain questionnaire?

Patients are typically asked to provide detailed information about their pain, including its duration, triggers, and any previous treatments they have tried.

What is the purpose of comprehensive pain questionnaire?

The purpose of comprehensive pain questionnaire is to gather important information about a patient's pain to help healthcare providers make an accurate diagnosis and develop an effective treatment plan.

What information must be reported on comprehensive pain questionnaire?

Information such as the onset of pain, aggravating and alleviating factors, and the impact of pain on daily activities should be reported on a comprehensive pain questionnaire.