Pain and Pain-Related Questionnaires

 

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Image of young doctor with a tablet talking to an older women with his hand on her shoulder.

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*

PEG Spanish

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 *

GAD-2 Spanish

Asks about the frequency of anxiety or uncontrollable worry over the past two weeks; available in Spanish 
Depression 

PHQ-2*

PHQ-2 Spanish

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*
TAPS1 

TAPS2

TAPS1 - Spanish

TAPS2 - Spanish

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 
B. translations available
C. Copyright 
D. Collection

Pain Location

 

Michigan Body Map (chronic pain)  

Spanish version
 

A. 1
B. English, Spanish
C. None
D. HEAL supplemental
 

UCSF Body Map 

A. 3
B. English
C. None
D. HEAL supplemental
 

Widespread Pain Index  

A. 27
B. English
C. None
D. HEAL supplemental

Chronic Overlapping Pain Conditions

 

Chronic Overlapping Pain Condition Screener   

A. Computer Adaptive test
B. English
C. Copyrighted
D. HEAL supplemental
Pain Behavior

PROMIS Pain Behavior 

A. 39
B. English, visit Healthmeasures.net for additional languages
C. None
D. HEAL supplemental

Pain Intensity

 

High Impact Chronic Pain

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

Copyrighted - Visit Wong-Baker FACES website for information

A. 1
B. English
C. Copyrighted
D. HEAL supplemental
Pain Quality

Brief Pain Inventory (BPI)

Copyrighted - Contact MD Anderson for information

A. 16-64
B. English, contact MD Anderson for additional languages
C. Copyrighted
D. HEAL supplemental
 

McGill Pain Questionnaire – Short Form (SF-MPQ) 

Copyrighted - Contact Mapi Research Trust for information

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 
B. translations
C. Copyright 
D. Collection

Arthritis

Knee Injury and Osteoarthritis Outcome Score (KOOS) Short Form 

Spanish Version

A. 12
B. English, Spanish
C. None
D. HEAL supplemental
 

Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 

Copyrighted - contact Mapi Research Trust for information

A. 24
B. English, contact Mapi Research Trust for additional languages
C. Copyrighted
D. HEAL supplemental
Fibromyalgia

Fibromyalgia Impact Questionnaire – Revised (FIQR) 

Copyrighted - Contact Mapi Research Trust for information

A. 21
B. English, contact Mapi Research Trust for additional languages
C. Copyrighted
D. HEAL supplemental
Headache/Migraine

Migraine Disability Assessment (MIDAS)

Copyrighted -contact Health Union LLC for information

A. 7
B. English contact Health Union LLC for additional Languages
D. HEAL supplemental
Low Back Pain

Oswestry Disability Index 

Copyrighted - Contact Mapi Research Trust for information

A. 10
B. English, contact Mapi Research Trust for additional languages
C. Copyrighted
D. HEAL supplemental
 

Roland Morris Disability Questionnaire  

A. 24
B. English, visit RMDQ website for additional languages
D. HEAL supplemental
 

The Keele STarT Back Screening Tool 

A. 9
B. English
C. None
D. HEAL supplemental
Neuropathic Pain

Douleur Neuropathique en 4 Questions (DN4)

Copyrighted - Contact Mapi Research Trust for information

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) 

Copyrighted - Contact IASP for information

A. 9
B. English Contact IASP for additional languages
C. Copyrighted
D. HEAL supplemental
 

painDetect

Copyrighted - Contact Pfizer for information

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) 

Copyrighted - Contact HealthMeasures.net for information

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 
B. translations
C. Copyright 
D. Collection

Quality of Life

Euro-QOL-5D - 5L (HEAL-Related Quality of Life for Economic Evaluation)  

Copyrighted - Contact EuroQol for information

A. 8
B. English, contact EuroQol for additional languages
C. Copyrighted
D. HEAL supplemental
 

Short Form Health Survey (SF-8)  

Copyrighted - Contact Quality Metric for information. 

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 
B. translations
C. Copyright 
D. Collection

Physical Activity

General Physical Activity Questionnaire (GPAQ) 

A. 16
B. English
C. None
D. HEAL supplemental
 

International Physical Activity Questionnaire (IPAQ - SF) 

A.  27
B. English
C. None
D. HEAL supplemental
 

Rapid Assessment of Physical Activity (RAPA)
 

Spanish Version

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

WHO Disability Assessment Schedule (WHODAS 2.0) 

A. 6
B. English
C. None
D. HEAL supplemental
Physical Performance

Beighton Score for General Hypermobility

A. 5
B. English
C. None
D. HEAL supplemental
 

Lower Extremity Neurological Testing - Sensory Tests

 

A. 7
B. English
C. None
D. HEAL supplemental
 

Stair Procedure

 

A. 8
B. English
C. None
D. HEAL supplemental
 

Two-Minute Walk Test

 

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 
B. translations
C. Copyright 
D. Collection

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) 

Copyrighted - Contact Mapi Research Trust for information

A. 21
B. English,  Contact Mapi Research Trust for additional languages
C. Copyrighted
D. HEAL supplemental
Neurocognitive Measures

Neurobehavioral Symptom Inventory (NSI) 

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

Copyrighted- Contact Mapi Research Trust for Information

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

Adverse Childhood Events (ACES)  

Spanish Version

A. 10
B. English, Spanish
C. None
D. HEAL supplemental
 

Trauma History Questionnaire 

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 
B. translations
C. Copyright 
D. Collection

Fatigue

Brief Fatigue Inventory (BFI) 

Copyrighted - Contact MD Anderson for information

A. 9
B. English, Contact MD Anderson for additional languages
C. Copyrighted
D. HEAL supplemental
 

Fatigue Severity Scale 

Copyrighted - Contact author for information

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 

Copyrighted- Contact Mapi Research Trust for information

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 
B. translations
C. Copyright 
D. Collection

Acceptance

Chronic Pain Acceptance Questionnaire 

A.  20
B. English
C. None
D. HEAL supplemental
Beliefs

Beliefs in Pain Control Questionnaire (BPCQ)  

A. 13
B. English
C. None
D. HEAL supplemental
 

Internalized Stigma in Chronic Pain 

A. 28
B. English
C. None
D. HEAL supplemental
Coping with Pain

Chronic Pain Coping Inventory (CPCI) 

Copyrighted - Contact PAR for information

A.  8
B. English Contact PAR for additional languages
C. Copyrighted
D. HEAL supplemental
 

Coping Strategies Questionnaire 

A. 2
B. English
C. None
D. HEAL supplemental
Expectations

Expectation of Pain Relief 

A. 1
B. English
C. None
D. HEAL supplemental
 

Experiences Questionnaire

Copyrighted - Contact for information

A. 20
B. English
C. None
D. HEAL supplemental
Concerns about Pain

Pain Anxiety Symptom Scale (PASS) 

A. 20-40
B. English,
C. None
D. HEAL supplemental
Fear of Pain

Fear-Avoidance Beliefs Questionnaire (FABQ) 

A.  16
B. English
C. None
D. HEAL supplemental
 

Tampa Scale for Kinesiophobia 

A. 11
B. English
C. None
D. HEAL supplemental
Resilience

Connor-Davidson Resilience Scale (CD-RISC) 

Copyrighted - Contact CD-RISC for information

A. 25
B. English, Contact CD-RISC for additional languages
D. HEAL supplemental
 

Pain Resilience Scale

Spanish Version 

A. 14
B. English, Spanish
C. None
D. HEAL supplemental
Self-Efficacy

Chronic Pain Self-Efficacy Scale (CPSES) 

A. 22
B. English
C. None
D. HEAL supplemental
Treatment Satisfaction

Patient Global Impression of Change (PGIC)  

Spanish Version

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 
B. translations
C. Copyright 
D. Collection

Discrimination

Everyday Discrimination Scale  

A. 13
B. English
C. None
D. HEAL supplemental
 

Perceived Discrimination 

A. 4
B. English
C. None
D. HEAL supplemental
Social Support

Multidimensional Scale of Perceived Social Support (MSPSS) 

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 
B. translations
C. Copyright 
D. Collection

Medication Adherence

Medication Adherence Report Scale - 5 item (MARS-5)

Copyrighted - Contact Elsevier for information

A. 11
B. English, Contact Elsevier for additional languages
C. Copyrighted
D. HEAL supplemental
 

Medication Quantification Scale-III (MSQ-III) 

A. 9
B. English
C. None
D. HEAL supplemental
Opioid Use

Current Opioid Misuse Measure (COMM) 

Copyrighted- Contact author for information

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) 

Copyrighted- Contact author for information

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.

 

 

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