To use the questionnaire, circle the words that describe your pain but do not circle more than one word in a group. Then when you have that done, go back and circle the three words in groups 1-10 that most convey your pain response. Pick the two words in groups 11-15 that do the same thing. Then pick one word in group 16. Finally, pick 1 word in groups 17-20. At the end you should have seven words that you can take to your doctor that will help describe both the quality of your pain and the intensity of it.
| Group |
Words |
| 1 |
Flickering, Pulsing, Quivering, Throbbing, Beating, Pounding |
| 2 |
Jumping, Flashing, Shooting |
| 3 |
Pricking, Boring, Drilling, Stabbing |
| 4 |
Sharp, Cutting, Lacerating |
| 5 |
Pinching, Pressing, Gnawing, Cramping, Crushing |
| 6 |
Tugging, Pulling, Wrenching |
| 7 |
Hot, Burning, Scalding, Searing |
| 8 |
Tingling, Itchy, Smarting, Stinging |
| 9 |
Dull, Sore, Hurting, Aching, Heavy |
| 10 |
Tender, Taut (tight), Rasping, Splitting |
| 11 |
Tiring, Exhausting |
| 12 |
Sickening, Suffocating |
| 13 |
Fearful, Frightful, Terrifying |
| 14 |
Punishing, Grueling, Cruel, Vicious, Killing |
| 15 |
Wretched, Blinding |
| 16 |
Annoying, Troublesome, Miserable, Intense, Unbearable |
| 17 |
Spreading, Radiating, Penetrating, Piercing |
| 18 |
Tight, Numb, Squeezing, Drawing, Tearing |
| 19 |
Cool, Cold, Freezing |
| 20 |
Nagging, Nauseating, Agonizing, Dreadful, Torturing |
You can use some words more than once.