| RPT |
|.|.|WHYMPI Pain Interference Scale (MPI-PAIN-INTRF) |
greater interference. | |
Question and Answers:| |
1. In general, how much does your pain problem interfere with your day to|
day activities? |
<*Answer_7961*>| |
2a. Are you retired from work for reasons other than your pain problem? |
<*Answer_7962*>| |
| Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>|
2. Since the time you developed a pain problem, how much has your pain|
changed your ability to work? |
<*Answer_7963*>| |
3. How much has your pain changed the amount of satisfaction or enjoyment you |
get from participating in social and creational activities?|
<*Answer_7964*>| |
4. How much has your pain changed your ability to participate in recreational|
and other social activities? |
Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>|
<*Answer_7965*>| |
5. How much has your pain changed the amount of satisfaction you get from|
family-related activities? |
<*Answer_7966*>| |
6. How much has your pain changed your marriage and other family|
relationships? |
<*Answer_7967*>| |
7a. Are you currently working? |
SSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
<*Answer_7968*>| |
7. How much has your pain changed the amount of satisfaction or enjoyment|
you get from work? |
<*Answer_7969*>| |
8. How much has your pain changed your ability to do household chores? |
<*Answer_7970*>| |
9. How much has your pain changed your friendships with people other than|
| Gender: <.Patient_Gender.>| |
your family? |
<*Answer_7971*>| |
Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic
purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities.
| |Copyright 1985, Robert D. Kerns, Dennis C. Turk, and Thomas E. Rudy
$~
Pain Interference: <*Answer_999999999999*> | |
Pain interference scores range from 0 to 6 with higher scores reflecting |
|
