CHRONIC / NEUROPATHIC PAIN EVALUATION

*1. Have you had pain persisting past three months after normal tissue healing, trauma, surgery or unknown cause?


*2. Has your pain interfered with your productivity at work, resulted in absenteeism or loss of employment?


*3. Has your pain impacted your quality of life and reduced your functional capabilities?


*4. Do you have difficulty organizing your thoughts or with memory or learning?


*5. Have you developed depression and anxiety?


*6. Does your pain include a burning sensation?


*7. Do you have a painful cold or freezing sensation?


*8. Do you have tingling or feeling of pins and needles?


*9. Do you have numbness or a sensation like wearing an invisible glove or sock?


*10. Do you have itching?


*11. Do you experience normal sensations like touch as extremely painful?


*12. Do you have a loss of balance or coordination?


*13. Do you have sharp,shooting, or electric- like pain?


*14. Have you tried various types of therapy for pain or prescription drugs and still failed to get sustained relief?


*15. Do you have a medical condition resulting in episodic or constant pain?