Pain Center - Quiz #2

Disclaimer: In no way does this survey constitute nor convey specific medical advise.

Keep track of how may times you answer Yes to the questions. This will help you find your score below.

Print your responses and bring with you to your appointment

Y N	1. Do you feel bad posture could be the cause of your back, or other pain?
Y N	2. Does your back hurt when you’ve been sitting at the computer for a while?
Y N	3. Have you suffered with neck pain for 3 months or more?
Y N	4. Have you suffered with back pain for 3 months or more?
Y N	5. Have you suffered with joint pain for 3 months or more?
Y N	6. Do you think that you have to put up with nagging pain?
Y N	7. Do you regularly take pain killers?
Y N	8. Do you expect to get stiffer as you get older?
Y N	9. Do you feel you have a problem with balance?
Y N	10. Do you suffer with stress headaches?
Y N	11. Would you like to feel more relaxed and grounded?
Y N	12. Are you physically and mentally tired when you wake up in the morning?
Y N	13. Do your knees “play up”?
Y N	14. Do you dislike standing for any length of time?
Y N	15. Do you find it hard going up and down stairs?
Y N	16. Do you suffer with sciatic pain?
Y N	17. Can you turn your head freely, to both sides?
Y N	18. Do you often worry that physical activity will cause more pain?
Y N	19. Do you find it hard to walk far?
Y N	20. Would you say you are a tense person?
Y N	21. Do you find it hard to put stress or irritation behind you?
Y N	22. Do you want to improve your breathing?
Y N	23. Do you lack energy?
Y N	24. Do you find it hard sitting in a car for long?
Y N	25. Are you willing to make changes that will enable you to get rid of the pain?