In the past 7 days…

Item Number

ID*

Items**

1

PAININ1

How difficult was it for you to take in new information because of pain?

2

PAININ3

How much did pain interfere with your enjoyment of life?

3

PAININ5

How much did pain interfere with your ability to participate in leisure activities?

4

PAININ6

How much did pain interfere with your close personal relationships?

5

PAININ8

How much did pain interfere with your ability to concentrate?

6

PAININ9

How much did pain interfere with your day to day activities?

7

PAININ10

How much did pain interfere with your enjoyment of recreational activities?

8

PAININ11

How often did you feel emotionally tense because of your pain?

9

PAININ12

How much did pain interfere with the things you usually do for fun?

10

PAININ13

How much did pain interfere with your family life?

11

PAININ17

How much did pain interfere with your relationships with other people?

12

PAININ18

How much did pain interfere with your ability to work (include work at home)?

13

PAININ19

How much did pain make it difficult to fall asleep?

14

PAININ20

How much did pain feel like a burden to you?

15

PAININ22

How much did pain interfere with work around the home?

16

PAININ31

How much did pain interfere with your ability to participate in social activities?

17

PAININ34

How much did pain interfere with your household chores?

18

PAININ35

How much did pain interfere with your ability to make trips from home that kept you gone for more than 2 hours?

19

PAININ36

How much did pain interfere with your enjoyment of social activities?

20

PAININ48

How much did pain interfere with your ability to do household chores?

21

PAININ49

How much did pain interfere with your ability to remember things?

22

PAININ56

How irritable did you feel because of pain?

23

PAININ14

How much did pain interfere with doing your tasks away from home (eg, getting groceries, running errands)?

24

PAININ16

How often did pain make you feel depressed?

25

PAININ24

How often was pain distressing to you?

26

PAININ26

How often did pain keep you from socializing with others?

27

PAININ29

How often was your pain so severe you could think of nothing else?

28

PAININ32

How often did pain make you feel discouraged?

29

PAININ37

How often did pain make you feel anxious?

30

PAININ38

How often did you avoid social activities because it might make you hurt more?

31

PAININ39

How often did pain make simple tasks hard to complete?

32

PAININ40

How often did pain prevent you from walking more than 1 mile?

33

PAININ42

How often did pain prevent you from standing for more than one hour?

34

PAININ46

How often did pain make it difficult for you to plan social activities?

35

PAININ47

How often did pain prevent you from standing for more than 30 minutes?

36

PAININ50

How often did pain prevent you from sitting for more than 30 minutes?

37

PAININ51

How often did pain prevent you from sitting for more than 10 minutes?

38

PAININ52

How often was it hard to plan social activities because you didn’t know if you would be in pain?

39

PAININ53

How often did pain restrict your social life to your home?

40

PAININ55

How often did pain prevent you from sitting for more than one hour?

41

PAININ54

How often did pain keep you from getting into a standing position?