Pain Disability Questionnaire: Scoring and Interpretation
The Pain Disability Questionnaire uses an 1I-point visual analog scale for
each item, with scores for each item ranging from 0-10 (full integers only).
The line of the visual analog scale is approximately 15 cm, so 1 .5 crn
equals one point and each tick mark on the line equals two points.
To score each item, assess where the patient places the "X" on the line and
choose the number that corresponds most closely to where the "Xu is
placed. Note that on there are no numbers displayed on the actual
questionnaire, so use the example shown betow to approximate the
number assignment.
If the "X" is exactly between two numbers , choose the lower number. If the
patient places two "Xs" on the line, choose the point exactly in between the
two "Xs" for scoring purposes. If the patient places more the two "Xs" on
the line, ask himlher to re-take the questionnaire. If the patient leaves an
item blank, ask himlher to complete the item. If the patient states that the
item is not applicable or helshe cannot answer it for any reason, do not
score the item as "On, but leave it blank. If there is more than one missing
item per test, score the entire test as "unreliable."
Write in the score for each item on the line to the right of the corresponding
item number on Page 2 of the actual questionnaire in the "Office Use Only"
section. Once you have scored each item and recorded all scores on Page
2 in the "Office Use Only" section, add the scores of the pertinent items to
calculate the Functional Status Component and Psychosocial Status
Component scores. Then, add the two component scores to derive the
Total PDQ score. Use the Total PDQ score for documentation.
For documentation, record the score as a ratio of the highest possible
score (e.g. 401150). The highest possible score the Functional Status
Component is 90, Psychosocial Status Component 60, and Total PDQ
score is 150.
Note: The higher the score, the higher level of disability; that is, lower
scores are better and improvement is displayed when scores are reduced.
c.l
Pain Disability Questionnaire
NAME:
DATE:
--
Please read:
This survey asks for your views about how your pain affects how you function in every day
activities. This information will help you and your doctor know how you feel and how well you
are able to do your daily tasks at this time.
Please answer every question by marking an "X" along the line to show how much your pain
problem has affected you (from having no problems at all to having the most severe problems
you can imagine).
1) Does your pain interfere with your normal work inside and outside the home?
I
Work normally
i
Unable to work at all
2) Does your pain interfere with personal care (such as washing, dressing, etc.)?
I
I
Take care of myself completely
A
Need help with all
my personal care
3) Does your pain interfere with your traveling?
I
I
Travel anywhere 1 like
I
I
Only travel to see doctors
4) Does your pain affect your ability to sit or stand?
I
No problems
I
Cannot do at all
5) Does your pain affect your ability to lift overhead, grasp objects, or reach for things?
No problems
I
Cannot do at a l l
6) Does your pain affect your ability to lift objects off the floor, bend, stoop, or squat?
I
No problems
Cannot do at all
7) Does your pain affect your ability to walk or run?
I
No problems
COMPLETE OTHER SIDE -b
I
Cannot do at all
8) Has your income declined since your pain began?
No decline
Lost all income
9) Do you have to take pain medication every day to control your pain?
+--1
-A
1
r
l
On pain medication
No me [cation needed
throughout the day
10) Does your pain force you to see doctors much tnore often than before your pain began?
1
Never see doctors
I
See doctors weekly
11) Does your pain interfere with your abjlity to see the people who are important to you
as much as you would like?
I
I
No problem
Never see them
12) Does your pain interfere with recreational activities and hobbies that are important to you?
L
No interference
Total interference
13) Do you need help of your family and friends to complete everyday tasks
(including both work outside the home and housework) because of your pain?
I
Never need help
I
Need help all the time
14) Do you now feel more depressed, tense, or anxious than before your pain began?
No depressionitension
I.1
Severe depress~onltension
15) Are there emotional problems caused by your pain that interfere with your
family, social, or work activities?
1
No problems
Severe problems
OFFICE USE ONLY
Functional: I----+2---+3
Psychosocial:
----
+4
---- + 5---- + 6---- + 7
8---+9---+10
-_-,
-_--+ 11----
12. ---
+ 14-_--
+ 15---- - -------
73----
TOTAL
-----7-
