Virtual Medical Centre
PAIN QUESTIONNAIRE
How would you assess your pain now, at this moment?
0 1 2 3 4 5 6 7 8 9 10
nonemax.
How strong was the strongest pain during the past 4 weeks?
0 1 2 3 4 5 6 7 8 9 10
nonemax.
How strong was the pain during the past 4 weeks on average?
0 1 2 3 4 5 6 7 8 9 10
nonemax.
Mark the picture that best describes the course of your pain:
Persistant pain with slight fluctuationsPersistant pain with slight fluctuations
Persistant pain with pain attacksPersistant pain with pain attacks
Pain attacks without pain between themPain attacks without pain between them
Pain attacks with pain between themPain attacks with pain between them
Please mark your
main area of pain



Does your pain radiate to other regions of your body?
yes no
  Do you suffer from a burning sensation (e.g., stinging nettles) in the marked areas?
  never hardly noticed slightly moderately strongly very strongly
  Do you have a tingling or prickling sensation in the area of your pain (like crawling ants or electrical tingling)?
  never hardly noticed slightly moderately strongly very strongly
  Is light touching (clothing, a blanket) in this area painful?
  never hardly noticed slightly moderately strongly very strongly
  Do you have sudden pain attacks in the area of your pain, like electric shocks?
  never hardly noticed slightly moderately strongly very strongly
  Is cold or heat (bath water) in this area occasionally painful?
  never hardly noticed slightly moderately strongly very strongly
  Do you suffer from a sensation of numbness in the areas that you marked?
  never hardly noticed slightly moderately strongly very strongly
  Does slight pressure in this area, e.g., with a finger, trigger pain?
  never hardly noticed slightly moderately strongly very strongly
   
R. Freynhagen, R. Baron, U. Gockel, T.R. Tölle, CurrMed ResOpin Vol 22, 2006, 1911-1920 © Pfizer Pharma GmbH 2006

E-mail this page Print this page
Mail this page Print icon
Close

This information will be collected for educational purposes, however it will remain anonymous.