Pain and Pain-Related Questionnaires

Pain is a subjective experience that can impact, and be impacted by, multiple domains of a person’s life, such as mental health and physical function. Given the biopsychosocial nature of pain, it is important to apply a biopsychosocial framework in clinical assessment and symptom monitoring.
Administering measures across biopsychosocial domains can facilitate discussions between the clinician and person living with pain to use a shared decision-making approach for determining the focus of treatment. This approach acknowledges that the person is the expert of their pain experience and involves them as an active participant in identifying valued areas of treatment. For example, beyond reduced pain intensity, the person might also hope to make gains in physical function, or have increased engagement in social activities.
Biopsychosocial assessment of pain can be facilitated by using measures across multiple life domains. Most of the measures below are derived from toolboxes or core outcomes sets (COS) that the NIH Pain Consortium and other NIH initiatives helped create or curate. These initiatives are described at the end of this page.
Commonly Used Pain and Pain-Related Questionnaires
Many measures exist to assess aspects of pain, its comorbidities, and physical function. Below is a set of brief measures that can be used to assess life domains that might be important to a person living with pain. It might be helpful for a clinician to administer this set of brief measures when a person first begins reporting pain or is new to the clinic. Elevated scores on any of these brief measure (or if the person expresses that a specific life domain is important to them) can be followed up using more comprehensive measures, which are provided later in this page.
Domain | Measure | Description |
---|---|---|
Pain Intensity/Pain Interference |
PEG* |
A 3-item instrument that asks people to rate their pain level (P) as well as how much pain has interfered with their enjoyment of life (E) and general activity (G) |
Anxiety |
GAD-2 * |
Asks about the frequency of anxiety or uncontrollable worry over the past two weeks; available in Spanish |
Depression | Asks 2 questions to inquire about frequency of anhedonia and feelings of depression; available in Spanish | |
Fatigue | Visual Analogue Fatigue Scale | A 1-item measure that asks about a person’s global level of fatigue severity on a scale of 0-10 |
Post-Traumatic Stress Disorder (PTSD) | Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) | A 5-item screener for symptoms associated with PTSD, such as nightmares and distressing emotional responses to a traumatic event |
Quality of Life | McGill 1-item QoL measure | Asks the person to rate their quality of life on a scale from very bad to excellent |
Sleep | DoD/VA Pain Supplemental Questions - Sleep | A 1-item measure on the degree to which pain has interfered with a person’s sleep |
Substance Use |
Tobacco, Alcohol, Prescription medication, and other Substance use Tool* |
A 2-stage screener that asks about frequency of substance use and experience with substance use of potential concern |
* NIH Helping End Addiction Long-term® Initiative (NIH HEAL Initiative) Common Data Element core pain measures
Additional Questionnaires to Consider Based on Domain
When a person living with pain has an elevated score on a brief measure, comprehensive measures can be administered at a future visit to better characterize the person’s concerns within that domain. Below is a list of comprehensive measures for a variety of domains.
General Pain Attributes
These measures assess attributes associated with a person’s pain, such as pain intensity, interference, and quality, regardless of the specific pain condition.
General Pain Attributes Measures
Domain
|
Measure
|
Characteristics A. # of items |
---|---|---|
Pain Location
|
Michigan Body Map (chronic pain) |
A. 1 B. English, Spanish C. None D. HEAL supplemental |
A. 3 B. English C. None D. HEAL supplemental |
||
A. 27 B. English C. None D. HEAL supplemental |
||
Chronic Overlapping Pain Conditions
|
A. Computer Adaptive test B. English C. Copyrighted D. HEAL supplemental |
|
Pain Behavior | A. 39 B. English, visit Healthmeasures.net for additional languages C. None D. HEAL supplemental |
|
Pain Intensity
|
A. 7 B. English C. None D. HEAL supplemental |
|
PROMIS Pain Intensity(pdf, 29 KB) |
A. 1 B. English visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
|
Wong-Baker FACES Pain Rating Scale |
A. 1 B. English C. Copyrighted D. HEAL supplemental |
|
Pain Quality |
Brief Pain Inventory (BPI) |
A. 16-64 B. English, contact MD Anderson for additional languages C. Copyrighted D. HEAL supplemental |
McGill Pain Questionnaire – Short Form (SF-MPQ) |
A. 22 B. English, Spanish - contact Mapi Research Trust for additional languages C. Copyrighted D. HEAL supplemental |
Condition-Specific Pain Attributes
These measures assess attributes associated with specific pain conditions, such as arthritis, fibromyalgia, and sickle cell disease.
Condition-Specific Pain Attributes Measures
Pain Condition |
Measure |
Characteristics A. # of items |
---|---|---|
Arthritis |
Knee Injury and Osteoarthritis Outcome Score (KOOS) Short Form |
A. 12 B. English, Spanish C. None D. HEAL supplemental |
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) |
A. 24 B. English, contact Mapi Research Trust for additional languages C. Copyrighted D. HEAL supplemental |
|
Fibromyalgia |
Fibromyalgia Impact Questionnaire – Revised (FIQR) |
A. 21 B. English, contact Mapi Research Trust for additional languages C. Copyrighted D. HEAL supplemental |
Headache/Migraine |
Migraine Disability Assessment (MIDAS) |
A. 7 B. English contact Health Union LLC for additional Languages D. HEAL supplemental |
Low Back Pain |
Oswestry Disability Index |
A. 10 B. English, contact Mapi Research Trust for additional languages C. Copyrighted D. HEAL supplemental |
A. 24 B. English, visit RMDQ website for additional languages D. HEAL supplemental |
||
A. 9 B. English C. None D. HEAL supplemental |
||
Neuropathic Pain |
Douleur Neuropathique en 4 Questions (DN4) |
A. 10 B. English, contact Mapi Research Trust for additional languages C. Copyrighted D. HEAL supplemental |
Leeds Assessment of Neuropathic Symptoms and Signs (self-complete) (S-LANSS Pain Score) |
A. 9 B. English Contact IASP for additional languages C. Copyrighted D. HEAL supplemental |
|
painDetect |
A. 14 B. English, contact Pfizer for additional languages C. Copyrighted D. HEAL supplemental |
|
PROMIS Neuropathic Pain Quality (pdf, 37 KB) |
A. 5 B. English, visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
|
Nociceptive Pain |
PROMIS Nociceptive Pain Quality(pdf, 37 KB) |
A. 5 B. English, visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
Sickle Cell Disease |
Adult Sickle Cell Quality of Life Measurement Information System (ASQ-Me) |
A. Computer Adaptive Testing B. English, Contact HealthMeasures.net for additional languages C. Copyrighted D. ASCQ-Me |
Quality of Life
Quality of life measures assess the degree to which an individual is healthy, comfortable, and able to participate in or enjoy life events.
Quality of Life Measures
Domain |
Measure |
Characteristics A. # of items |
---|---|---|
Quality of Life |
Euro-QOL-5D - 5L (HEAL-Related Quality of Life for Economic Evaluation) |
A. 8 B. English, contact EuroQol for additional languages C. Copyrighted D. HEAL supplemental |
Short Form Health Survey (SF-8) |
A. 8 B. English, contact Quality Metric for additional languages D. HEAL supplemental |
|
World Health Organization Quality of Life Brief Version (WHOQOL-BREF)
|
A. 34 B. English C. None D. HEAL supplemental |
Physical Function and Disability
Although a person’s level of physical function and activity does not reflect their level of pain, pain can impact physical function, and physical activity can impact pain. These measures, either through self-report or observer rating, assess the degree to which individuals can perform certain activities requiring physical actions.
Physical Function and Disability Measures
Domain |
Measure |
Characteristics A. # of items |
---|---|---|
Physical Activity | A. 16 B. English C. None D. HEAL supplemental |
|
A. 27 B. English C. None D. HEAL supplemental |
||
A. 9 B. English, Spanish C. None D. HEAL supplemental |
||
Physical Function |
PROMIS Ability to Participate in Social Roles and Activities(pdf, 32 KB) Spanish Version(pdf, 101 KB) |
A. 8 B. English, Spanish, visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
PROMIS Instrumental Support(pdf, 32 KB) Spanish Version(pdf, 108 KB) |
A. 8 B. English, Spanish, visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
|
PROMIS Physical Functioning(pdf, 32 KB) |
A. Computer Adaptive Testing and 4-item short form available B. English, visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
|
Pain Interference |
PROMIS Pain Interference(pdf, 133 KB) |
A. 8 B. English, visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
Disability | A. 6 B. English C. None D. HEAL supplemental |
|
Physical Performance | A. 5 B. English C. None D. HEAL supplemental |
|
Lower Extremity Neurological Testing - Sensory Tests
|
A. 7 B. English C. None D. HEAL supplemental |
|
|
A. 8 B. English C. None D. HEAL supplemental |
|
|
A. 6 B. English C. None D. HEAL supplemental |
Mental Health Status
Pain can negatively impact mental health and unmanaged mental health symptoms can exacerbate pain. Mental health assessment during a pain care visit might unintentionally invalidate a person’s pain experience if not done with care. A provider’s empathy and humility can help create a trustworthy space for a person to discuss their mental health concerns. The measures below assess mental health symptoms and their severity.
Mental Health Status Measures
Domain |
Measure |
Characteristics A. # of items |
---|---|---|
Anxiety |
Hospital Anxiety and Depression Scale (HADS) Copyrighted - Contact Gl-Assessment for information
|
A. 14 B. English, contact Gl-Assessment for additional languages C. Copyrighted D. HEAL supplemental |
State Trait Anxiety Copyrighted - Contact Mind Garden for information
|
A. 40 B. English, Contact Mind Garden for additional languages C. Copyrighted D. HEAL supplemental |
|
Depression |
Beck Depression Inventory Copyrighted - Contact Pearson Assessment for information
|
A. 21 B. English, Contact Pearson Assessment for additional languages C. Copyrighted D. HEAL supplemental |
Hamilton Rating Scale of Depression (HAMD) |
A. 21 B. English, Contact Mapi Research Trust for additional languages C. Copyrighted D. HEAL supplemental |
|
Neurocognitive Measures | A. 22 B. English C. None D. HEAL supplemental |
|
PROMIS Cognitive Function Abilities(pdf, 138 KB) |
A. 4 B. English, visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
|
Stress |
Perceived Stress Scale |
A. 10 B. English, Contact Mapi Research Trust for additional languages C. Copyrighted D. HEAL supplemental |
Suicidal Ideation |
Columbia-Suicide Severity Rating Scale Copyrighted - Contact Columbia Lighthouse Project for information |
A. 13-18 B. English, Contact Columbia Lighthouse Project for additional languages C. copyrighted D. HEAL supplemental |
Trauma | A. 10 B. English, Spanish C. None D. HEAL supplemental |
|
A. 24 B. English C. None D. HEAL supplemental |
Sleep and Fatigue
Pain can interfere with sleep, and poor sleep can exacerbate pain. The measures below assess aspects of fatigue (experience of extreme tiredness), sleepiness (difficulty staying awake/alert), and sleep (quality of sleep or presence/severity of insomnia symptoms).
Sleep and Fatigue Measures
Domain |
Measure |
Characteristics A. # of items |
---|---|---|
Fatigue |
Brief Fatigue Inventory (BFI) |
A. 9 B. English, Contact MD Anderson for additional languages C. Copyrighted D. HEAL supplemental |
Fatigue Severity Scale |
A. 9 B. English, Contact author for additional languages C. Copyrighted D. HEAL supplemental |
|
PROMIS Fatigue(pdf, 131 KB) Spanish Version(pdf, 186 KB) |
A. 8 B. English, Spanish C. None D. PROMIS; HEAL supplemental |
|
Sleep |
Insomnia Severity Index |
A. 7 B. English, Contact Mapi Research Trust for additional languages D. HEAL supplemental |
Pittsburgh Sleep Quality Index Copyrighted - Contact University of Pittsburg for information |
A. 9 B. English, Contact University of Pittsburg for additional languages C. Copyrighted D. HEAL Core |
|
PROMIS Sleep Disturbance(pdf, 32 KB) Spanish Version(pdf, 175 KB) |
A. 4 B. English visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
|
PROMIS Sleep-Related Impairment (pdf, 31 KB) Spanish Version(pdf, 169 KB) |
A. 8 B. English, Spanish visit Healthmeasures.net for additional languages C. None D. PROMIS; HEAL supplemental |
|
Sleepiness |
Epworth Sleepiness Scale Copyrighted - Contact Mapi Research Trust for information
|
A. 8 B. English, Contact Mapi Research Trust for additional languages C. Copyrighted D. HEAL supplemental |
Cognitive and Affective Pain and Treatment Factors
Assessing cognitive and affective factors related to pain and treatment can help identify a person’s beliefs, expectations, and concerns related to pain and treatment that might influence treatment responses. Further, it can help identify areas of coping and resilience to leverage a person’s strengths in treatment.
Cognitive and Affective Pain and Treatment Factors Measures
Domain |
Measure |
Characteristics A. # of items |
---|---|---|
Acceptance | A. 20 B. English C. None D. HEAL supplemental |
|
Beliefs | A. 13 B. English C. None D. HEAL supplemental |
|
A. 28 B. English C. None D. HEAL supplemental |
||
Coping with Pain |
Chronic Pain Coping Inventory (CPCI) |
A. 8 B. English Contact PAR for additional languages C. Copyrighted D. HEAL supplemental |
A. 2 B. English C. None D. HEAL supplemental |
||
Expectations | A. 1 B. English C. None D. HEAL supplemental |
|
Experiences Questionnaire |
A. 20 B. English C. None D. HEAL supplemental |
|
Concerns about Pain | A. 20-40 B. English, C. None D. HEAL supplemental |
|
Fear of Pain | A. 16 B. English C. None D. HEAL supplemental |
|
A. 11 B. English C. None D. HEAL supplemental |
||
Resilience |
Connor-Davidson Resilience Scale (CD-RISC) |
A. 25 B. English, Contact CD-RISC for additional languages D. HEAL supplemental |
A. 14 B. English, Spanish C. None D. HEAL supplemental |
||
Self-Efficacy | A. 22 B. English C. None D. HEAL supplemental |
|
Treatment Satisfaction | A. 1 B. English, Spanish C. None D. HEAL Core |
Social Contributors to Health
The burden of pain is inequitably distributed so that individuals from minoritized and marginalized groups tend to experience higher impact chronic pain yet poorer treatment in pain care. Understanding social contributors to pain and health can characterize additional areas for intervention, such as coping with discrimination, leveraging social supports, and addressing resource needs.
Social Contributors to Health Measures
Domain |
Measure |
Characteristics A. # of items |
---|---|---|
Discrimination | A. 13 B. English C. None D. HEAL supplemental |
|
A. 4 B. English C. None D. HEAL supplemental |
||
Social Support | A. 12 B. English C. None D. HEAL supplemental |
Medication and Substance Use
Chronic pain is not a unique risk factor for concerning substance use. In primary care settings, people with and without chronic pain are similarly at risk for concerning substance use. Further, studies have shown that most people with co-occurring chronic pain and substance use disorder experienced concerning substance use prior to the onset of their chronic pain. Yet, many people with chronic pain alone experience stigma based on perceived substance use disorder. It is important that clinicians use a high level of intentionality and humility in assessing substance use to avoid stigmatizing people with chronic pain.
Medication and Substance Use Measures
Domain |
Measure |
Characteristics A. # of items |
---|---|---|
Medication Adherence |
Medication Adherence Report Scale - 5 item (MARS-5) |
A. 11 B. English, Contact Elsevier for additional languages C. Copyrighted D. HEAL supplemental |
A. 9 B. English C. None D. HEAL supplemental |
||
Opioid Use |
Current Opioid Misuse Measure (COMM) |
A. 17 B. English, Contact author for additional languages C. Copyrighted D. HEAL supplemental |
Screener and Opioid Assessment for Patients with Pain Revised (SOAPP-R) |
A. 25 B. English C. Copyrighted D. HEAL supplemental |
|
Pain Medication Misuse |
PROMIS Prescription Pain Medication Misuse(pdf, 61 KB) |
A. 7 B. English C. None D. PROMIS; HEAL supplemental |
Explanation of Collections:
PROMIS Measures
PROMIS is a set of brief questionnaires that helps evaluate and monitor an individual’s physical, mental, and social health. There are many validated PROMIS measures available, and more information about PROMIS measures can be found here. PROMIS questionnaires relevant to pain and its comorbidities are available to measure pain intensity, pain interference, pain quality, pain behaviors, physical function, self-efficacy for managing symptoms or medications, anxiety, depression, fatigue, and sleep disturbance.
NIH Toolbox
The NIH Toolbox contains comprehensive 30-minute batteries to assess cognitive, emotional, sensory and motor functions. It is appropriate for use in general population, people with chronic conditions and people of all ages. Within the sensation measures battery, this toolbox assesses two pain related domains – Pain Interference and Pain Intensity. These pain measures are stand-alone measures but are included in the toolbox as part of a battery of measures meant to assess sensation.
NIDA Clinical Trials Network Common Data Elements
The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) has a set of standardized, measures that make up their common data elements (CDEs). These measures make up a consensus-based set of CDEs that can be used for the screening and initial assessment of substance use disorders (SUDs) that can be use in research and general medical settings. These measures are used by all trials supported by the NIDA CTN. Though these CDEs are designed for SUD research they assess two pain-specific domains. https://cde.drugabuse.gov/instruments
NIH HEAL® Core Common Data Elements
NIH staff, in collaboration with NIH HEAL® Initiative investigators and other pain research experts, went through a comprehensive process to identify nine core pain domains that should be assessed in HEAL studies and the questionnaires that should be used to measure each domain. Questionnaires were identified for the nine pain domains: pain intensity; pain interference; physical functioning/quality of life; sleep; pain catastrophizing; depression; anxiety; global satisfaction with treatment; and substance use. For more information, please see the NIH HEAL Initiative common data elements web page: https://heal.nih.gov/data/common-data-elements. Beyond the core CDEs, the NIH HEAL Initiative investigators are using hundreds of other questionnaires in their studies and these make up the HEAL CDE supplemental questionnaire collection.
Chronic Overlapping Pain Conditions Screener (COPCS)
The COPCS is an assessment tool that helps in the identification of different COPCs that may co-exist within a given individual. The COPCS site provides a video demo of the COPCS in use, a downloadable user's guide, access to a working demo version of the COPCS, and a link for obtaining a license to acquire an executable version for use with REDCap. Conditions of use: Students, physicians, clinical practice, and not-funded academic users may access the questionnaire and/or its available translations directly (see tutorial). Funded academic users, healthcare organizations, and commercial users & IT companies may have fees that apply to their project and can submit a request (see tutorial).
ASCQ-Me® Adult Sickle Cell Quality of Life Measurement Information System
ASCQ-Me is a set of self-report measures for use with adults with sickle cell disease that was developed through a collaboration between the National Heart, Lung, and Blood Institute (NHLBI) and the American Institutes for Research (AIR). Information related to the development of this measure can be found here and here. Measures assess physical, mental, and social health as well as information about the severity of one’s disease.