Pain Questionnaire

Pain may be related to many other secondary health concerns. Pain can be intensified when the body is not optimally detoxifying.  Proper assessment and a treatment plan are important to optimize one’s health.
This subjective questionnaire will give your health care practitioner a quick summary of symptoms or signs that may be related to your degree of overall digestive risk.  It is not a substitute for professional medical advice from your health care provider

Part 1:

1.____ The pain I experience was after a trauma

2. ____ The pain I experience is in the muscles

3.____ The pain I experience is in the joints

4. ____ The pain I experience changes with the weather

5. ____ The pain I experience changes with my monthly hormonal cycle

6. ____ The pain I experience increases after certain movements, which are_______________________________

7. ____ I experience “ aura “ like symptoms before the pain comes on

8. ____ I become sensitive to light and noise when I have the pain

9. ____ The pain is worse when I don’t drink enough

10. ____ The pain changes locations

11. ____ I experience digestive upset often

If you have answered 2 or more it is recommended that you consult your health care professional

To book an appointment

Part Two: The McGill Pain Questionnaire, also known as McGill pain index, is a scale of rating pain developed at McGill University by Melzack and Torgerson in 1971.

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.

Sample McGill Pain Questionnaire[1]

Group 1 Flickering, Pulsing, Quivering, Throbbing, Beating, Pounding

Group 2 Jumping, Flashing, Shooting

Group 3 Pricking, Boring, Drilling, Stabbing

Group 4 Sharp, Gritting, Lacerating

Group 5 Pinching, Pressing, Gnawing, Cramping, Crushing

Group 6 Tugging, Pulling, Wrenching

Group 7 Hot, Burning, Scalding, Searing

Group 8 Tingling, Itching, Smarting, Stinging

Group 9 Dull, Sore, Hurting, Aching, Heavy

Group 10 Tender, Taut (tight), Rasping, Splitting

Group 11 Tiring, Exhausting

Group 12 Sickening, Suffocating

Group 13 Fearful, Frightful, Terrifying

Group 14 Punishing, Grueling, Cruel, Vicious, Killing

Group 15 Wretched, Binding

Group 16 Annoying, Troublesome, Miserable, Intense, Unbearable

Group 17 Spreading, Radiating, Penetrating, Piercing

Group 18 Tight, Numb, Squeezing, Drawing, Tearing

Group 19 Cool, Cold, Freezing

Group 20 Nagging, Nauseating, Agonizing, Dreadful, Torturing
You can use some words more than once.

It is recommended to consult with your health care professional team.

To book an appointment.