| Code | Display |
| mpq-1000 | Please describe the location(s) of any pain you have had in the past 7 days (e.g., lower back and left hip) |
| mpq-1001 | In the past 7 days - How intense was your pain at its worst? |
| mpq-1002 | In the past 7 days - How intense was your average pain? |
| mpq-1003 | In the past 7 days - What is your level of pain right now? |
| mpq-1004 | In the past 7 days - How much did pain interfere with your day to day activities? |
| mpq-1005 | In the past 7 days - How much did pain interfere with your work? |
| mpq-1006 | In the past 7 days - How much did pain interfere with your ability to participate in social activities? |
| mpq-1007 | In the past 7 days - How much did pain interfere with your household chores? |
| mpq-1008 | How often have Exercises at home (such as those assigned by a therapist) or outside (such as walking, jogging, swimming) you have tried in the past 6 months helped you with your pain? |
| mpq-1009 | How often have Sleep positioners or devices (such as additional pillows, padding, etc.) you have tried in the past 6 months helped you with your pain? |
| mpq-1010 | How often has Stretching you have tried in the past 6 months helped you with your pain? |
| mpq-1011 | How often has Weight loss or changes in your diet you have tried in the past 6 months helped you with your pain? |
| mpq-1012 | How often has Setting and reaching activity goals you have tried in the past 6 months helped you with your pain? |
| mpq-1013 | How often has Ice or heat therapy you have tried in the past 6 months helped you with your pain? |
| mpq-1014 | How often has Physical therapy you have tried in the past 6 months helped you with your pain? |
| mpq-1015 | How often has Acupuncture you have tried in the past 6 months helped you with your pain? |
| mpq-1016 | How often has Chiropractic treatment you have tried in the past 6 months helped you with your pain? |
| mpq-1017 | How often have Pain relievers (such as Advil, Aleve, Aspirin, Ibuprofen, Motrin, Tylenol) you can buy without a prescription from your doctor that you have used in the last 6 months helped with your pain? |
| mpq-1018 | How often have Herbal or nutritional pain relievers (such as ginseng or kava kava) that you have used in the last 6 months helped with your pain? |
| mpq-1019 | How often have Cremes, lotions, gels or patches applied to the skin (for example Bengay, Tiger Balm or BioFreeze) that you have used in the last 6 months helped with your pain? |
| mpq-1020 | How often have prescription Opioid medications (such as hydrocodone, oxycodone, codeine, morphine and fentanyl) helped with your pain in the last 6 months? |
| mpq-1021 | How often have prescription Cortisone injections (a shot to relieve inflammation) helped with your pain in the last 6 months? |
| mpq-1022 | How often have prescription Non-opioid medications as prescribed by a doctor (such as Celebrex, Cymbalta) helped with your pain in the last 6 months? |
| mpq-1023 | How often has Yoga helped with your pain in the last 6 months? |
| mpq-1024 | How often has Massage helped with your pain in the last 6 months? |
| mpq-1025 | How often has Meditation helped with your pain in the last 6 months? |
| mpq-1026 | How often has Relaxation or mindfulness-based training helped with your pain in the last 6 months? |
| mpq-1027 | How often has Group or individual therapy for pain helped with your pain in the last 6 months? |
| mpq-1028 | How often has Acceptance and commitment therapy helped with your pain in the last 6 months? |
| mpq-1029 | How often has Sleep management (such as a sleep study or CPAP) helped with your pain in the last 6 months? |
| mpq-1030 | How often has Aromatherapy helped with your pain in the last 6 months? |
| mpq-1031 | How often have Crystals helped with your pain in the last 6 months? |
| mpq-1032 | How often have Essential oils helped with your pain in the last 6 months? |
| mpq-1033 | How often has Music therapy helped with your pain in the last 6 months? |
| mpq-1034 | Have you tried any Other new treatments to help with your pain in the last 6 months? Please describe |
| mpq-1035 | What are your most important activity goals? For example: I’d like to be able to walk without pain. |
| mpq-1036 | What are the biggest barriers to achieving your activity goals? For example: I have a lot of stress from work which makes my pain worse. |
| mpq-1037 | DEPRECATED |
| mpq-1038 | What type of HEAD pain have you had in the last 7 days? |
| mpq-1039 | What type of NECK pain have you had in the last 7 days? |
| mpq-1040 | What type of SHOULDERS pain have you had in the last 7 days? |
| mpq-1041 | What type of ARMS pain have you had in the last 7 days? |
| mpq-1042 | What type of UPPER BACK pain have you had in the last 7 days? |
| mpq-1043 | What type of LOWER BACK pain have you had in the last 7 days? |
| mpq-1044 | What type of HANDS pain have you had in the last 7 days? |
| mpq-1045 | What type of ABDOMEN pain have you had in the last 7 days? |
| mpq-1046 | What type of PELVIS pain have you had in the last 7 days? |
| mpq-1047 | What type of HIPS pain have you had in the last 7 days? |
| mpq-1048 | What type of UPPER LEGS pain have you had in the last 7 days? |
| mpq-1049 | What type of KNEES pain have you had in the last 7 days? |
| mpq-1050 | What type of LOWER LEGS pain have you had in the last 7 days? |
| mpq-1051 | What type of FEET pain have you had in the last 7 days? |
| mpq-1052 | What type of EVERYWHERE pain have you had in the last 7 days? |
| mpq-1053 | What OTHER pain have you had in the last 7 days? Please describe |
| mpq-1054 | How often have Other strategies or methods you have tried in the last 6 months helped with your pain? Please describe |
| mpq-1055 | Have you used any Other items you can buy without a prescription from your doctor to help with your pain in the last 6 months? Please describe |
| mpq-1056 | How often has Medical marijuana helped with your pain in the last 6 months? |
| mpq-1057 | Have you used any Other prescription medications to help with your pain in the last 6 months?: Please describe |
| mpq-1058 | How often has Cognitive behavioral therapy helped with your pain in the last 6 months? |
| mpq-1059 | Have you tried any Other mind-body techniques or therapies to help with your pain in the last 6 months? Please describe |
| mpq-1060 | How often has CBD oil helped with your pain in the last 6 months? |
| mpq-1061 | Did the patient view the 4 flat tires video |
| mpq-1062 | Did the patient access the US Chronic Pain website |
| mpq-1063 | Please indicate your level of agreement with the following statement: Using the MyPAIN tool has helped me begin preparing for a conversation with my provider about managing my pain. |
| mpq-1064 | Do you have any other feedback or thoughts to share on your use of MyPAIN? |
| mpq-1065 | When did the patient submit their questionnaire response? |
| mpq-1066 | What type of BACK pain have you had in the last 7 days? |
| mpq-1067 | What type of HANDS/WRIST pain have you had in the last 7 days? |
| mpq-1068 | What type of ABDOMEN/PELVIS pain have you had in the last 7 days? |
| mpq-1069 | What type of FEET/ANKLES pain have you had in the last 7 days? |
| mpq-1070 | Over-the-counter pain reliever (such as Advil, Aleve, Aspirin, Ibuprofen, Motrin, or Tylenol) |
| mpq-1071 | Prescription nonsteroidal anti-inflammatory (such as Celebrex) |
| mpq-1072 | Prescription nerve pain medication (such as Lyrica, Neurontin, or Cymbalta) |
| mpq-1073 | Prescription muscle relaxant (such as Soma or Baclofen) |
| mpq-1074 | Prescription opioid medication (such as Vicodin, hydrocodone, oxycodone, codeine, morphine, or tramadol) |
| mpq-1075 | Other: describe other medications you've tried for pain |
| mpq-1076 | I haven't tried any medications for pain. |
| mpq-1077 | I haven't seen any specialists for pain |
| mpq-1078 | Dry needling or cupping |
| mpq-1079 | Acupuncture |
| mpq-1080 | I haven't tried any procedures or physical treatments for pain. |
| mpq-1081 | I haven't tried any topical treatments or devices for pain. |
| mpq-1082 | I haven't tried any lifestyle changes for pain. |
| mpq-1083 | What topical treatments or devices have you tried for pain? |
| mpq-1084 | What alternative treatments have you tried for pain? |
| mpq-1085 | I haven’t tried any alternative treatments for pain |
| mpq-1086 | What specialists have you seen for pain? |
| mpq-1087 | Chiropractor |
| mpq-1088 | Physical therapist |
| mpq-1089 | Pain management specialist |
| mpq-1090 | Orthopedist |
| mpq-1091 | Psychologist or counselor |
| mpq-1092 | Integrative medicine specialist |
| mpq-1093 | Other: describe other specialists you have seen for pain (such as neurologist, spine doctor rheumatologist, or physiatrist) |
| mpq-1094 | Surgery |
| mpq-1095 | Injection (such as a shot to relieve inflammation) |
| mpq-1096 | Massage |
| mpq-1097 | Other: describe other procedures or physical treatments you've tried for pain |
| mpq-1098 | What topical treatments or devices have you tried for pain? |
| mpq-1099 | Heat and/or ice |
| mpq-1100 | Topical medications (such as creams, lotions, gel, patches, Bengay, Tiger Balm, Salonpas, Biofreeze, or Lidoderm) |
| mpq-1101 | TENs unit |
| mpq-1102 | Bracing |
| mpq-1103 | Other: describe other topical treatments or devices you've tried for pain |
| mpq-1104 | Exercises or stretching (such as walking, yoga, water aerobics) |
| mpq-1105 | Diet or hydration (such as an anti-inflammatory diet or drinking enough water) |
| mpq-1106 | Weight loss |
| mpq-1107 | Stress reduction (such as relaxation, meditation, mindfulness, laughter) |
| mpq-1108 | Posture or ergonomics |
| mpq-1109 | Other: describe other lifestyle changes you've tried for pain |
| mpq-1110 | Herbal treatments or supplements (such as ginseng or kava kava) |
| mpq-1111 | Aromatherapy |
| mpq-1112 | CBD oil |
| mpq-1113 | Marijuana used for medical purposes |
| mpq-1114 | Other: describe other alternative treatments you've tried for pain |
| mpq-1115 | Activity Goals: what goals do you have for your daily activities? |
| mpq-1116 | "Activity Goals: what are the biggest barriers to achieving your daily activity goals? |
| pain-location | Please describe the location(s) of any pain you have had in the past 7 days. |
| my-pain-intensity | Thinking about your overall pain, in the past 7 days, please respond to the questions below: |
| my-pain-interference | Thinking about your overall pain, in the past 7 days, please respond to the questions below: |
| about-my-treatments | My Treatments Questionnaire Grouping Code |
| about-my-goals | We'd like to know more about you and your goals |
| mypain-feedback | Feedback on your use of MyPAIN |
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