Pain Disability Questionnaire

The Pain Disability Questionnaire is used in Chapter 3 Pain (6th ed, 43-44) and Chapter 17 Spine (6th ed, 599-600). The format provided utilizes a centimeter scale to score, however the size in the Guides does not correspond with the same scale. An alternative approach (illustrated below) provides easily administered and scored numerical scales.

Patient Name ________________________________________________________ Date ___________________________

Instructions: These questions ask your views about how your pain now affects how you function in everyday activities. Please answer every question and mark the ONE number on EACH scale that best describes how you feel.