Brief Pain Inventory (Short Form)

DASS21

Please read each statement and circle a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows;

0 = Did not apply to me at all

1 = Applied to me to some degree, or some of the time

2 = Applied to me to a considerable degree, or a good part of time

3 = Applied to me very much, or most of the time  

PC Scale

Everyone experiences painful situations at some point in their lives. Such experiences may include  headaches, tooth pain, joint or muscle pain. People are often exposed to situations that may cause pain such as illness, injury, dental procedures or surgery.

Instructions: We are interested in the types of thoughts and feelings that you have when you are in pain. Listed below are thirteen statements describing different thoughts and feelings that may be associated with pain. Using the following scale, please indicate the degree to which you have these thoughts and feelings when you are experiencing pain.  

Rating;

0 = Not at all

1 = To a slight degree

2 = To a moderate degree

3 = To a great degree

4 = All the time

Pain SE Questionnaire

Please rate how confident you are that you can do the following things at present despite the pain. To indicate your answer circle one of the numbers for each item, where 0 = not at all confident and 6 = completely confident.

Remember this questionnaire is not asking whether or not you have been doing these things, but rather how confident you are that you can do them at present, despite the pain.

Administration