Pain Disability Questionnaire

pain disability questionnaire name answer the following questions on a scale of 0 10 of how you feel right now performing each activity of daily living since the accident/trauma has taken place does your pain interfere with your normal work inside and outside the home? work normally unable to work at all does your pain interfere with personal care (such as washing, dressing, etc )? take care of myself completely need help with my personal care does your pain interfere with your traveling? travel anywhere i like only travel to see doctors does your pain affect your ability to sit or stand? no problems cannot sit/stand at all does your pain affect your ability to lift overhead, grasp objects, or reach for things? no problems cannot do at all does your pain affect your ability to lift objects off the floor, bend, stoop, or squat? no problems cannot do at all does your pain affect the ability to walk or run? no problems cannot walk/run at all has your income declined since your pain began? no decline lost all income do you have to take pain medication every day to control your pain? no medication needed on pain medication throughout the day does your pain force you to see doctors much more often than before your pain began? never see doctors see doctors weekly does your pain interfere with your ability to see the people who are important to you as much as you would like? no problems never see them does your pain interfere with recreational activities and hobbies that are important to you? no interference total interference do you need help of your family and friends to complete everyday tasks because of your pain? never need help need help all the time do you now feel more depressed, tense, or anxious than before your pain? no depression / tension severe depression/tension are there emotional problems caused by your pain that interfere with your family, social, and/or work activities? no problems severe problems