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LOW BACK PAIN QUESTIONNAIRE
This questionnaire is derived from medical research profiling chronic low back pain sufferers.
Please take your time and answer each question.
- Do you feel your problem low back contributes to overall poor health? Y/N
- Do you believe physical activity makes your low back pain worse? Y/N
- Have you stopped participating in certain activities because of the irritation it causes to your low back? Y/N
- Do you avoid normal activities when these activities cause low back pain? Y/N
- Has your low back pain created increased anxiety in your life? Y/N
- Are you hoping your low back will get better? Y/N
- Research shows that unrelenting or recurrent low back pain is associated with depression. Do you feel your low back pain makes you depressed? Y/N
- Do you feel you don't have the control in your life you should because of an unreliable low back? Y/N
- At times do you feel like giving up on any hope of a good recovery? Y/N
- Do you feel the various avenues of therapy you've tried so far have cost you a lot of time and money and have not helped? Y/N
- Can you envision your low back pain getting worse and having more negative impact on your life? Y/N
Score: Yes ____ No ____
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Click on this icon to pull the questionnaire into Word and print it out.
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| As a rehabilitation specialist it is my opinion that if you answer 3 or more of these questions "yes" this indicates your pain is likely to continue and your activity levels are likely to decrease.
If this is the case, I feel it worth your time you to come in and explore our non-invasive options. When employed, these strategies could stimulate healing and offer significant and sustainable pain relief.
With less pain you can participate in a more active lifestyle, enjoy better overall health, suffer less anxiety and re-establish better control of your life. The time for hoping for effective treatment may be over. Come and find out what many of our patients have already have discovered.
Should you decide to come in, although not necessary, it would be helpful if you were to bring in this completed questionnaire along with any available reports (orthopedic evaluation, neurology evaluation, X-rays, MRIs or CT scans).
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