Brief Pain Inventory form

For the first 3 questions, please select a value that best describes your pain.

0 = no pain at all | 10 = the worst pain you can imagine.

At its WORST in the LAST WEEK *

At its LEAST in the LAST WEEK *

On average *

For the remaining questions, please choose the number that best describes how DURING THE PAST WEEK pain has interfered with the following:

0 = does not interfere | 10 = completely interferes

General Activity *

Mood *

Walking ability *

Sleep *

Enjoyment of life *

Full name *

Please do not fill in this field.

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