In the past seven days, how frequently...

 
Never
1-4 days
5-7 days
Does not apply
I prefer to skip

..did your pain prevent you from preparing a typical meal for yourself?

..did your pain prevent you from performing your typical daily hygiene routine?

..did your pain prevent you from physical therapy or your other exercise(s)?

..did your pain interfere with walking as much as you normally would?

..did your pain prevent you from performing tasks such as folding a load of laundry or loading the dishwasher?

..did your pain cause you to cancel or skip activities you enjoy?

..did you feel a need to distract yourself from your pain such as trying to 'zone out' to music, tv or movies, reading or listening to an audio book?

..did you have pain so intense that distraction was impossible?

..did your pain prevent you from your routine driving?

..did your pain interfere with your ability to fall asleep?

..did your pain wake you from sleep?