Take this Self Assessment Quiz. If you have a persistent problem with pain, please complete this questionnaire and discuss it with your physical therapist or doctor.

1. Does your pain limit your mobility?

yes no

2. Do you find your pain influencing your choice of leisure activities and vacations, and does it keep you from the things you like to do?

yes no

3. How would you classify your pain?

a. Generally mild: the pain is infrequent and manageable, and I can go on about life
b. Mild to moderate : I can do things, but I have a certain degree of pain
c. moderate to severe; pain on a daily basis that severely limits my activities and the things I want to do
d. severe: the pain drastically limits my activities and makes routine functions very difficult

4. Has your pain been getting worse over the past few months?

yes no

5. Do you take any medications to relieve your pain?

yes no

6. Have you found that your prescription medicine is not helping as much or at all like it used to?

yes no

7. Have you discussed your pain condition with your physical therapist or doctor?

yes no

8. If you take prescription medicines for your pain, how satisfied are you with their results:

a. very satisfied
b. somewhat satisfied
c. neither satisfied nor dissatisfied
d. somewhat dissatisfied
e. very dissatisfied

9. Have you been told by your doctor that there is nothing more they can do to help your condition?

yes no

10. Do you find walking or climbing stairs uncomfortable?

yes no

11. If yes, how many minutes can you walk before pain makes you uncomfortable?

a. less than 2 minutes
b. between 3 and 5 minutes
c. 6 to 9 minutes
d. 10 to 15 minutes
e. more than 15 minutes

Click here for the answers.