|
How severe is your pain?
|
No pain – intolerable
|
|
How severe is your pain at night?
|
No pain – intolerable
|
|
Do you get relief from painkillers?
|
Complete relief – no relief
|
|
How stiff is your thoracic spine?
|
No stiffness – intolerable stiffness
|
|
Do you have discomfort when looking upwards?
|
None at all – intolerable
|
|
Do you have discomfort when turning your head to the sides?
|
None at all – intolerable
|
|
Does your pain interfere with your ability to work with your hands overhead?
|
No interference – completely unable to work with hands overhead
|
|
Does your pain interfere with your ability to comb your hair?
|
No interference – completely unable to comb hair
|
|
Does you pain interfere with your ability to put on your coat?
|
No interference – completely unable to put on coat
|
|
How severe is your pain when lying down in bed?
|
No pain – intolerable
|
|
What is your overall handicap in your complete lifestyle because of your pain?
|
Completely free to perform any task – totally handicapped
|
|
To what extent does your pain interfere with your work?
|
No interference at all – totally incapable to work
|
|
To what extent have you had to modify your work in order to be able to do your job?
|
No adjustment to work – so much adjustment that you have had to change your job
|
