| 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? |