Pain Disability Questionnaire (PDQ)
<br><br>

1. Does your pain interfere with your normal work inside and outside the home?<br>
Work normally<br>
Unable to work at all<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>
2. Does your pain interfere with personal care (such as washing, dressing, etc.)?<br>
Take care of myself completely<br>
Need help with all my personal care<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>


3. Does your pain interfere with your traveling?<br>
Travel anywhere I like<br>
Only travel to see doctors<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>

4. Does your pain affect your ability to sit or stand?<br>
No problems<br>
Cannot sit / stand at all<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>
5. Does your pain affect your ability to lift overhead, grasp objects, or reach for things?<br>
No problems<br>
Cannot do at all<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>
6. Does your pain affect your ability to lift objects off the floor, bend, stoop, or squat?<br>
No problems<br>
Cannot do at all<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>
7. Does your pain affect your ability to walk or run?<br>
No problems<br>
Cannot walk / run at all<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>
8. Has your _______ declined since your pain began?<br>
No decline<br>
Lost all ______<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>
9. Do you have to take pain medication every day to control your pain?<br>
No medication needed<br>
On pain medication throughout the day<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>

10. Does your pain force you to see doctors much more often than before your pain began?<br>
Never see doctors<br>
See doctors weekly<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>

11. Does your pain interfere with your ability to see the people who are important to you as much as you would like?<br>
No problem<br>
Never see them<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>

12. Does your pain interfere with recreational activities and hobbies that are important to you?
<br>
No interference<br>
Total interference<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>

13. Do you need the help of your family and friends to complete everyday tasks (including both work outside the home
and housework) because of your pain?<br>
Never need help<br>
Need help all the time<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>


14. Do you now feel more depressed, tense, or anxious than before your pain began?<br>
No depression / tension<br>
Severe depression / tension<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>

15. Are there emotional problems caused by your pain that interfere with your family, social, and / or work activities?<br>
No problems<br>
Severe problems<br>
0 -------- 1 -------- 2 -------- 3 -------- 4 -------- 5 -------- 6 -------- 7 -------- 8 -------- 9 -------- 10<br><br>