Brief pain inventory (BPI)

BRIEF PAIN INVENTORY (BPI)

PAIN LOCATION
Q1. What are the areas where you feel pain?
A1.

PAIN SEVERITY
Rating scale (0-10) 0 = No pain, 10 = Pain as bad as you can imagine.

Q2. Rate your pain at its WORST in the last week: 
Q3. Rate your pain at its LEAST in the last week: 
Q4. Rate your pain ON AVERAGE in the last week: 
Q5. Rate your pain RIGHT NOW:

Pain severity score, add the scores for questions 2, 3, 4 and 5, then divide by 4.

Pain severity score:

TREATMENT
Q6. What treatments or medications are you receiving for your pain?
A6.

Q7. In the last week, how much relief have pain treatments or medications provided? 
(No relief = 0%, complete relief = 100%)
A7.

PAIN INTERFERENCE
Rating scale (0-10) 0 = Does not interfere, 10 = Completely interferes.

Q8a. General activity: 
Q8b. Mood: 
Q8c. Walking ability: 
Q8d. Normal work (includes both outside the home and housework): 
Q8e. Relations with other people: 
Q8f. Sleep: 
Q8g. Enjoyment of life:

Pain interference score, add the scores for questions 8a, b, c, d, e, f and g, then divide by 7).

Pain interference score:

Comments:

Brief pain inventory (BPI)

Related items