Information:
Fel:
ID
41756
Beskrivning
Otis-Green, S., & The City of Hope Pain/Palliative Resource Center. (2012) . The Psychosocial Pain Assessment Form (PPAF). Measurement Instrument Database for the Social Science. Retrieved 12.01.2021, from www.midss.ie. Key references: Otis-Green, S. (2006). Psychosocial Pain Assessment Form. In Dow (Ed.), Nursing Care of Women with Cancer. St. Louis, MO: Elsevier Mosby, 556-561. Otis-Green, S. (2005). Psychosocial Pain Assessment Form. In Kuebler, Davis, Moore (Eds.), Palliative Practices: An Interdisciplinary Approach. St. Louis, MO: Elsevier Mosby, 462-467. Primary use / Purpose: The Psychosocial Pain Assessment Form (PPAF) is a comprehensive assessment form for measuring psychosocial pain. It does so under five domains: economic, social support, activities of daily living, emotional impact, and coping style. Additionally, an assessment of prior history is included to help clinicians focus interventions where sexual abuse or other traumatic memories are present. Background: The psychosocial model of pain is now widely accepted. Pain is no longer treated, or thought of, as a purely physiological condition, but instead, one that is the product of a myriad of both psychological and physiological factors. For this reason, there is a need for instruments which measure the full range of outcomes and causes associated with chronic pain, whether they be psychological, economic, or physiological. The Psychosocial Pain Assessment Form (PPAF) was developed to be used in this capacity. Digital Object Identifier (DOI): http://dx.doi.org/10.13072/midss.344
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Nyckelord
Versioner (1)
- 2021-01-13 2021-01-13 -
Rättsinnehavare
Otis-Green, S., & The City of Hope Pain/Palliative Resource Center
Uppladdad den
13 januari 2021
DOI
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Creative Commons BY 4.0
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Measurement Instrument Database for the Social Science (MIDSS)
The Psychosocial Pain Assessment Form (PPAF)
- StudyEvent: ODM
Similar models
The Psychosocial Pain Assessment Form (PPAF)
- StudyEvent: ODM
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Psychosocial Pain Assessment Form
C0030193 (UMLS CUI-1)
C1455743 (UMLS CUI-2)
C1455743 (UMLS CUI-2)
Patient name
Item
Patient
text
C1299487 (UMLS CUI [1])
Age
Item
Age
text
C0001779 (UMLS CUI [1])
Date in time
Item
Date
date
C0011008 (UMLS CUI [1])
Medical record number
Item
Med. Record #
integer
C1301894 (UMLS CUI [1])
Partner in relationship
Item
Significant Other
text
C0682323 (UMLS CUI [1])
Diagnosis
Item
Diagnosis
text
C0011900 (UMLS CUI [1])
Primary physician
Item
Primary Physician
text
C1508823 (UMLS CUI [1])
Pain Disorder
Item
Pain Syndrome
text
C0391976 (UMLS CUI [1])
Pain, Duration
Item
Duration of Pain
text
C0030193 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
C0449238 (UMLS CUI [1,2])
Pain, Psychosocial assessment, Health professional
Item
Assessed by
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C1704312 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C1704312 (UMLS CUI [1,3])
CL Item
Cachectic (1)
CL Item
Thin Medium (2)
CL Item
Heavy (3)
CL Item
Obese (4)
CL Item
Disheveled (1)
CL Item
Hospitalized (2)
CL Item
Casual (3)
CL Item
Professional (4)
CL Item
Avoided (1)
CL Item
Appropriate (2)
CL Item
Stared (3)
CL Item
Distracted (1)
CL Item
Focused (2)
CL Item
Hypervigilant (3)
CL Item
Flat (1)
CL Item
Depressed (2)
CL Item
Distant (3)
CL Item
Cooperation (4)
CL Item
Engaging (5)
CL Item
Humorous (6)
CL Item
Dramatic (7)
CL Item
Agitated (8)
CL Item
Anxious (9)
CL Item
Tearful (10)
CL Item
Sobbing (11)
CL Item
Defensive (12)
CL Item
Sarcastic (13)
CL Item
Argumentative (14)
CL Item
Angry (15)
CL Item
Hostile (16)
CL Item
Tense (1)
CL Item
Vague (2)
CL Item
Average (3)
CL Item
Articulate (4)
CL Item
Verbose (5)
CL Item
Impaired (1)
CL Item
Age-Appropriate (2)
CL Item
Advanced (3)
CL Item
Pessimistic (1)
CL Item
Optimistic (2)
CL Item
Unrealistic (3)
CL Item
Realistic (4)
Pain, Psychosocial assessment, Impressions
Item
Impressions
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C1998467 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C1998467 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Interventional procedure
Item
Interventions
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0184661 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0184661 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Recommendations
Item
Recommendations
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0034866 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0034866 (UMLS CUI [1,3])
Item Group
Rating (0-10; 0 = no concern, 10 = greatest concern)
C0030193 (UMLS CUI-1)
C1455743 (UMLS CUI-2)
C0681889 (UMLS CUI-3)
C1455743 (UMLS CUI-2)
C0681889 (UMLS CUI-3)
Pain, Psychosocial assessment, Economic
Item
Economic - Interviewer
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Economic
Item
Economic - Patient
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Economic
Item
Economic - Significant Other
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Social support
Item
Social Support - Interviewer
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0037438 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0037438 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Social support
Item
Social Support - Patient
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0037438 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0037438 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Social support
Item
Social Support - Significant Other
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0037438 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0037438 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Activities of Daily Living
Item
Activities of daily living - Interviewer
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Activities of Daily Living
Item
Activities of daily living - Patient
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Activities of Daily Living
Item
Activities of daily living - Significant Other
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Emotional Well-being
Item
Emotional - Interviewer
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C2984554 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C2984554 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Emotional Well-being
Item
Emotional - Patient
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C2984554 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C2984554 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Emotional Well-being
Item
Emotional - Significant Other
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C2984554 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C2984554 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Coping Behavior
Item
Coping - Interviewer
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Coping Behavior
Item
Coping - Patient
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
Pain, Psychosocial assessment, Coping Behavior
Item
Coping - Significant Other
integer
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
Item Group
Economic
C0030193 (UMLS CUI-1)
C1455743 (UMLS CUI-2)
C0013557 (UMLS CUI-3)
C1455743 (UMLS CUI-2)
C0013557 (UMLS CUI-3)
CL Item
Work (1)
CL Item
Family (2)
CL Item
Disability (3)
CL Item
Partner (4)
CL Item
Retirement/Pensions (5)
CL Item
Other (6)
CL Item
Friends (7)
CL Item
Savings (8)
Item
Some people we see are concerned about meeting their economic needs. Which of these are worrisome to you?
text
C0013557 (UMLS CUI [1,1])
C2699424 (UMLS CUI [1,2])
C2699424 (UMLS CUI [1,2])
Code List
Some people we see are concerned about meeting their economic needs. Which of these are worrisome to you?
CL Item
None (1)
CL Item
Housing (2)
CL Item
Food (3)
CL Item
Clothing (4)
CL Item
Prescriptions (5)
CL Item
Childcare (6)
CL Item
Insurance (7)
CL Item
Medical bills (8)
CL Item
Other (9)
Item
How has your economic situation changed?
text
C0337781 (UMLS CUI [1,1])
C0443172 (UMLS CUI [1,2])
C0443172 (UMLS CUI [1,2])
CL Item
Better (1)
CL Item
Worse (2)
Economic Status, Changed status
Item
Describe
text
C0337781 (UMLS CUI [1,1])
C0443172 (UMLS CUI [1,2])
C0443172 (UMLS CUI [1,2])
Economic Status, Changed status, Feeling upset
Item
How upsetting have these changes been to you? Describe
text
C0337781 (UMLS CUI [1,1])
C0443172 (UMLS CUI [1,2])
C3887804 (UMLS CUI [1,3])
C0443172 (UMLS CUI [1,2])
C3887804 (UMLS CUI [1,3])
Economic Status, Patient Wish
Item
What would be different in your life if you could afford to change it? Describe
text
C0337781 (UMLS CUI [1,1])
C0443172 (UMLS CUI [1,2])
C3887804 (UMLS CUI [1,3])
C0747309 (UMLS CUI [1,4])
C0443172 (UMLS CUI [1,2])
C3887804 (UMLS CUI [1,3])
C0747309 (UMLS CUI [1,4])
Item
Please rate your overall level of concern regarding these economic issues (0-10; 0 = no concern at all; 10 = greatest concern) - Interviewer
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding these economic issues (0-10; 0 = no concern at all; 10 = greatest concern) - Interviewer
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
5 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
Please rate your overall level of concern regarding these economic issues (0-10; 0 = no concern at all; 10 = greatest concern) - Patient
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding these economic issues (0-10; 0 = no concern at all; 10 = greatest concern) - Patient
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
5 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
Please rate your overall level of concern regarding these economic issues (0-10; 0 = no concern at all; 10 = greatest concern) - Significant Other
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0013557 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding these economic issues (0-10; 0 = no concern at all; 10 = greatest concern) - Significant Other
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
5 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item Group
Social Support
C0030193 (UMLS CUI-1)
C1455743 (UMLS CUI-2)
C0037438 (UMLS CUI-3)
C1455743 (UMLS CUI-2)
C0037438 (UMLS CUI-3)
Item
Who do you turn to when you're uncomfortable or in pain?
text
C0030193 (UMLS CUI [1,1])
C0037438 (UMLS CUI [1,2])
C0037438 (UMLS CUI [1,2])
CL Item
Self (1)
CL Item
Others (2)
CL Item
God (3)
Item
Name
text
C0030193 (UMLS CUI [1,1])
C0037438 (UMLS CUI [1,2])
C0027365 (UMLS CUI [1,3])
C0037438 (UMLS CUI [1,2])
C0027365 (UMLS CUI [1,3])
Item
Relationship
text
C0030193 (UMLS CUI [1,1])
C0037438 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
C0037438 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
Pain, Social support, Accessibility
Item
How accessible is this person to you?
text
C0030193 (UMLS CUI [1,1])
C0037438 (UMLS CUI [1,2])
C0814423 (UMLS CUI [1,3])
C0037438 (UMLS CUI [1,2])
C0814423 (UMLS CUI [1,3])
Pain, Social support, Helpful
Item
How helpful is this to you?
text
C0030193 (UMLS CUI [1,1])
C0037438 (UMLS CUI [1,2])
C3898897 (UMLS CUI [1,3])
C0037438 (UMLS CUI [1,2])
C3898897 (UMLS CUI [1,3])
Feelings, Sharing
Item
How comfortable are you sharing your feelings/fears with your loved ones? What makes this difficult for you? Describe
text
C1527305 (UMLS CUI [1,1])
C0237876 (UMLS CUI [1,2])
C0237876 (UMLS CUI [1,2])
Communication, Physicians
Item
How satisfied are you with communication with your doctor/medical team? Describe
text
C0009452 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,2])
Recent loss of close family member &or friend
Item
Losing people who are important to us affects us deeply. Have you suffered any recent losses?
boolean
C1716700 (UMLS CUI [1])
Recent loss of close family member &or friend
Item
Losing people who are important to us affects us deeply. Have you suffered any recent losses? Describe
text
C1716700 (UMLS CUI [1])
Item
Losing people who are important to us affects us deeply. Have you suffered any recent losses? Describe
text
C1716700 (UMLS CUI [1])
Code List
Losing people who are important to us affects us deeply. Have you suffered any recent losses? Describe
CL Item
Breaking up (1)
CL Item
Separation (2)
CL Item
Divorce (3)
CL Item
Death (4)
CL Item
Moving away (5)
CL Item
Other (6)
Item
Please rate your overall level of concern regarding these social support issues (0-10; 0 = no concern, 10 = greatest concern) - Interviewer
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding these social support issues (0-10; 0 = no concern, 10 = greatest concern) - Interviewer
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
Please rate your overall level of concern regarding these social support issues (0-10; 0 = no concern, 10 = greatest concern) - Patient
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding these social support issues (0-10; 0 = no concern, 10 = greatest concern) - Patient
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
Please rate your overall level of concern regarding these social support issues (0-10; 0 = no concern, 10 = greatest concern) - Significant Other
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding these social support issues (0-10; 0 = no concern, 10 = greatest concern) - Significant Other
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item Group
Activities of Daily Living
C0030193 (UMLS CUI-1)
C1455743 (UMLS CUI-2)
C0001288 (UMLS CUI-3)
C1455743 (UMLS CUI-2)
C0001288 (UMLS CUI-3)
Pain, Affection, Sleep behavior finding
Item
Often unrelieved pain affects a person's daily routine. How has your pain impacted you in these activities of daily living? 1. Affecting your sleeping patterns?
boolean
C0030193 (UMLS CUI [1,1])
C0474396 (UMLS CUI [1,2])
C0474396 (UMLS CUI [1,2])
Item
1. Affecting your sleeping patterns?
text
C0030193 (UMLS CUI [1,1])
C0474396 (UMLS CUI [1,2])
C0474396 (UMLS CUI [1,2])
CL Item
Frequent napping (1)
CL Item
Nightmares (2)
CL Item
Drowsiness (3)
CL Item
Chronic Fatigue (4)
CL Item
Difficulty going to sleep (5)
CL Item
Difficulty staying asleep (6)
CL Item
Difficulty waking up (7)
CL Item
Other (8)
Pain, Eating habit
Item
2. Affecting your eating habits?
boolean
C0030193 (UMLS CUI [1,1])
C1266864 (UMLS CUI [1,2])
C1266864 (UMLS CUI [1,2])
Item
2. Affecting your eating habits?
text
C0030193 (UMLS CUI [1,1])
C1266864 (UMLS CUI [1,2])
C1266864 (UMLS CUI [1,2])
CL Item
Weight loss/gain (1)
CL Item
Loss of appetite (2)
CL Item
Nausea/vomiting (3)
CL Item
Changes in taste (4)
CL Item
Special Diet (5)
CL Item
Feeding Tube (6)
CL Item
Difficulty swallowing (7)
CL Item
Other (8)
Pain, Personal Hygiene
Item
3. Affecting your hygiene/elimination habits?
boolean
C0030193 (UMLS CUI [1,1])
C0564673 (UMLS CUI [1,2])
C0564673 (UMLS CUI [1,2])
Item
3. Affecting your hygiene/elimination habits?
text
C0030193 (UMLS CUI [1,1])
C0564673 (UMLS CUI [1,2])
C0564673 (UMLS CUI [1,2])
CL Item
Diarrhea (1)
CL Item
Catheter (2)
CL Item
Difficulty Grooming (3)
CL Item
Difficulty Bathing (4)
CL Item
Constipation (5)
CL Item
Ostomy (6)
CL Item
Incontinence (7)
CL Item
Other (8)
Pain, Ability to move
Item
4. Affecting your ability to move?
boolean
C0030193 (UMLS CUI [1,1])
C0578670 (UMLS CUI [1,2])
C0578670 (UMLS CUI [1,2])
Item
4. Affecting your ability to move?
text
C0030193 (UMLS CUI [1,1])
C0578670 (UMLS CUI [1,2])
C0578670 (UMLS CUI [1,2])
CL Item
Generalized weakness (1)
CL Item
Bed bound (2)
CL Item
Crutches/walker/cane (3)
CL Item
Getting in/out of car (4)
CL Item
Lifting/carrying (5)
CL Item
No longer athletic (6)
CL Item
Limited range of motion (7)
CL Item
Wheel chair (8)
CL Item
Walking/standing (9)
CL Item
Climbing stairs (10)
CL Item
Other (11)
CL Item
S.O.B. (12)
Pain, Family role
Item
5. Affecting your roles in your family?
boolean
C0030193 (UMLS CUI [1,1])
C4721573 (UMLS CUI [1,2])
C4721573 (UMLS CUI [1,2])
Pain, Family role
Item
5. In what ways?
text
C0030193 (UMLS CUI [1,1])
C4721573 (UMLS CUI [1,2])
C4721573 (UMLS CUI [1,2])
Pain, Sexual function
Item
6. Affecting your sexual functioning?
boolean
C0030193 (UMLS CUI [1,1])
C0278092 (UMLS CUI [1,2])
C0278092 (UMLS CUI [1,2])
Pain, Sexual function
Item
6. In what ways?
text
C0030193 (UMLS CUI [1,1])
C0278092 (UMLS CUI [1,2])
C0278092 (UMLS CUI [1,2])
Pain, General appearance
Item
7. Affecting your physical appearance?
boolean
C0030193 (UMLS CUI [1,1])
C1148438 (UMLS CUI [1,2])
C1148438 (UMLS CUI [1,2])
Pain, General appearance
Item
7. In what ways?
text
C0030193 (UMLS CUI [1,1])
C1148438 (UMLS CUI [1,2])
C1148438 (UMLS CUI [1,2])
Item
8. How has your energy level changed?
text
C0030193 (UMLS CUI [1,1])
C1442080 (UMLS CUI [1,2])
C1442080 (UMLS CUI [1,2])
CL Item
Less (1)
CL Item
Same (2)
CL Item
Improved (3)
Item
9. Please rate your overall level of concern regarding these physical changes (0-10; 0 = no concern, 10 = greatest concern) - Interviewer
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
Code List
9. Please rate your overall level of concern regarding these physical changes (0-10; 0 = no concern, 10 = greatest concern) - Interviewer
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
9. Please rate your overall level of concern regarding these physical changes (0-10; 0 = no concern, 10 = greatest concern) - Patient
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
Code List
9. Please rate your overall level of concern regarding these physical changes (0-10; 0 = no concern, 10 = greatest concern) - Patient
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
9. Please rate your overall level of concern regarding these physical changes (0-10; 0 = no concern, 10 = greatest concern) - Significant Other
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0001288 (UMLS CUI [1,3])
Code List
9. Please rate your overall level of concern regarding these physical changes (0-10; 0 = no concern, 10 = greatest concern) - Significant Other
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item Group
Emotional
C0030193 (UMLS CUI-1)
C1455743 (UMLS CUI-2)
C0600015 (UMLS CUI-3)
C1455743 (UMLS CUI-2)
C0600015 (UMLS CUI-3)
Depressive disorder
Item
Have you been troubled by feelings of: Depression
boolean
C0011581 (UMLS CUI [1])
Depressive disorder
Item
Have you been troubled by feelings of: Depression - Describe
text
C0011581 (UMLS CUI [1])
Frustration, Anger
Item
Have you been troubled by feelings of: Frustration/Anger
boolean
C0016770 (UMLS CUI [1,1])
C0002957 (UMLS CUI [1,2])
C0002957 (UMLS CUI [1,2])
Frustration, Anger
Item
Have you been troubled by feelings of: Frustration/Anger - Describe
text
C0016770 (UMLS CUI [1,1])
C0002957 (UMLS CUI [1,2])
C0002957 (UMLS CUI [1,2])
Anxiety
Item
Have you been troubled by feelings of: Anxiety
boolean
C0003467 (UMLS CUI [1])
Anxiety
Item
Have you been troubled by feelings of: Anxiety - Describe
text
C0003467 (UMLS CUI [1])
Panic Attacks
Item
Have you been troubled by feelings of: Panic Attacks
boolean
C0086769 (UMLS CUI [1])
Panic Attacks
Item
Have you been troubled by feelings of: Panic Attacks - Describe
text
C0086769 (UMLS CUI [1])
Mood swings
Item
Have you been troubled by feelings of: Mood Swings
boolean
C0085633 (UMLS CUI [1])
Mood swings
Item
Have you been troubled by feelings of: Mood Swings - Describe
text
C0085633 (UMLS CUI [1])
Difficulty concentrating
Item
Have you been troubled by feelings of: Difficulty Concentrating
boolean
C0947509 (UMLS CUI [1])
Difficulty concentrating
Item
Have you been troubled by feelings of: Difficulty Concentrating - Describe
text
C0947509 (UMLS CUI [1])
Loss of motivation
Item
Have you been troubled by feelings of: Loss of Motivation
boolean
C0456814 (UMLS CUI [1])
Loss of motivation
Item
Have you been troubled by feelings of: Loss of Motivation - Describe
text
C0456814 (UMLS CUI [1])
See or hear things that weren't there
Item
Do you ever see or hear things that others don't?
boolean
C3844000 (UMLS CUI [1])
See or hear things that weren't there
Item
Do you ever see or hear things that others don't? - Describe
text
C3844000 (UMLS CUI [1])
Medical procedure, Fear
Item
Are there any medical tests or procedures that frighten you?
boolean
C0199171 (UMLS CUI [1,1])
C0015726 (UMLS CUI [1,2])
C0015726 (UMLS CUI [1,2])
Medical procedure, Fear
Item
Are there any medical tests or procedures that frighten you? - Describe
text
C0199171 (UMLS CUI [1,1])
C0015726 (UMLS CUI [1,2])
C0015726 (UMLS CUI [1,2])
Feeling suicidal
Item
Have you ever thought about hurting yourself or taking your life?
boolean
C0424000 (UMLS CUI [1])
Feeling suicidal
Item
Have you ever thought about hurting yourself or taking your life? - Describe
text
C0424000 (UMLS CUI [1])
Item
Please rate your overall level of concern regarding these emotional issues (0-10; 0 = no concern, 10 = greatest concern) - Interviewer
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding these emotional issues (0-10; 0 = no concern, 10 = greatest concern) - Interviewer
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
Please rate your overall level of concern regarding these emotional issues (0-10; 0 = no concern, 10 = greatest concern) - Patient
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding these emotional issues (0-10; 0 = no concern, 10 = greatest concern) - Patient
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
Please rate your overall level of concern regarding these emotional issues (0-10; 0 = no concern, 10 = greatest concern) - Significant Other
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0600015 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding these emotional issues (0-10; 0 = no concern, 10 = greatest concern) - Significant Other
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item Group
Coping
C0030193 (UMLS CUI-1)
C1455743 (UMLS CUI-2)
C0009967 (UMLS CUI-3)
C1455743 (UMLS CUI-2)
C0009967 (UMLS CUI-3)
Item
Sometimes, doing things we enjoy distracts us from our pain. What activities are you able to do that you enjoy?
text
C0023292 (UMLS CUI [1,1])
C4316940 (UMLS CUI [1,2])
C4316940 (UMLS CUI [1,2])
Code List
Sometimes, doing things we enjoy distracts us from our pain. What activities are you able to do that you enjoy?
CL Item
None (1)
CL Item
Family (2)
CL Item
Religion (3)
CL Item
Art/Music (4)
CL Item
Friends (5)
CL Item
Gardening (6)
CL Item
TV (7)
CL Item
Hobbies (8)
CL Item
Traveling (9)
CL Item
Pets (10)
CL Item
Reading (11)
CL Item
Exercise (12)
CL Item
Other (13)
Spirituality
Item
Some people find comfort in spirituality to help them cope with difficult situations. What role does spirituality have in helping you? - Describe
text
C0237104 (UMLS CUI [1])
Pain, Sense of purpose
Item
Many people in your situation ask "Why did this happen to me?" How have you attempted to "make sense" of your painful experiences? - Describe
text
C0030193 (UMLS CUI [1,1])
C0424089 (UMLS CUI [1,2])
C0424089 (UMLS CUI [1,2])
Stress
Item
Past stressful events can impact us in the present. What kinds of stress have you had to handle before? - Describe
text
C0038435 (UMLS CUI [1])
Child abuse behavior
Item
What kinds of stress have you had to handle before? - Child abuse?
boolean
C0008060 (UMLS CUI [1])
Child abuse behavior
Item
What kinds of stress have you had to handle before? - Child abuse? - Describe
text
C0008060 (UMLS CUI [1])
Sexual abuse
Item
What kinds of stress have you had to handle before? - Sexual abuse?
boolean
C0282350 (UMLS CUI [1])
Sexual abuse
Item
What kinds of stress have you had to handle before? - Sexual abuse? - Describe
text
C0282350 (UMLS CUI [1])
Family Violence
Item
What kinds of stress have you had to handle before? - Family violence?
boolean
C0206072 (UMLS CUI [1])
Family Violence
Item
What kinds of stress have you had to handle before? - Family violence? - Describe
text
C0206072 (UMLS CUI [1])
Counseling
Item
Have you ever been in counseling?
boolean
C0010210 (UMLS CUI [1])
Counseling, Attention
Item
What was the focus of your therapy?
text
C0010210 (UMLS CUI [1,1])
C0004268 (UMLS CUI [1,2])
C0004268 (UMLS CUI [1,2])
Support Groups
Item
Have you ever attended a support group?
boolean
C0036606 (UMLS CUI [1])
Support Groups
Item
What kind?
text
C0036606 (UMLS CUI [1])
Support Group, Helpful
Item
How helpful was this?
text
C0036606 (UMLS CUI [1,1])
C3898897 (UMLS CUI [1,2])
C3898897 (UMLS CUI [1,2])
Item
Some people are prescribed medications to help them cope. Which of these have you been prescribed?
text
C0013227 (UMLS CUI [1])
Code List
Some people are prescribed medications to help them cope. Which of these have you been prescribed?
CL Item
None (1)
CL Item
Other (2)
Anti-Anxiety Agents
Item
Anti-Anxiety medications?
boolean
C0040616 (UMLS CUI [1])
Anti-Anxiety Agents
Item
Anti-Anxiety medications? - Describe
text
C0040616 (UMLS CUI [1])
Antidepressive Agents
Item
Anti-Depressant medications?
boolean
C0003289 (UMLS CUI [1])
Antidepressive Agents
Item
Anti-Depressant medications? - Describe
text
C0003289 (UMLS CUI [1])
Analgesics
Item
Pain Medications?
boolean
C0002771 (UMLS CUI [1])
Analgesics
Item
Pain Medications? - Describe
text
C0002771 (UMLS CUI [1])
Pharmaceutical Preparations, Prescribed
Item
Do you ever take your prescriptions differently than ordered?
boolean
C0013227 (UMLS CUI [1,1])
C0278329 (UMLS CUI [1,2])
C0278329 (UMLS CUI [1,2])
Pharmaceutical Preparations, Prescribed
Item
Do you ever take your prescriptions differently than ordered? - Describe
text
C0013227 (UMLS CUI [1,1])
C0278329 (UMLS CUI [1,2])
C0278329 (UMLS CUI [1,2])
Tobacco use
Item
Tobacco?
boolean
C0543414 (UMLS CUI [1])
Tobacco use
Item
Tobacco? - Describe
text
C0543414 (UMLS CUI [1])
Alcohol consumption
Item
Alcohol?
boolean
C0001948 (UMLS CUI [1])
Alcohol consumption
Item
Alcohol? - Describe
text
C0001948 (UMLS CUI [1])
Recreational Drugs
Item
Recreational Drugs?
boolean
C0242508 (UMLS CUI [1])
Recreational Drugs
Item
Recreational Drugs? - Describe
text
C0242508 (UMLS CUI [1])
Chemicals, Stop, Attempt
Item
Have you ever tried to stop using these?
boolean
C0220806 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
C1516084 (UMLS CUI [1,3])
C2746065 (UMLS CUI [1,2])
C1516084 (UMLS CUI [1,3])
Chemicals, Stop, Attempt
Item
Have you ever tried to stop using these? - Describe
text
C0220806 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
C1516084 (UMLS CUI [1,3])
C2746065 (UMLS CUI [1,2])
C1516084 (UMLS CUI [1,3])
Chemicals, Family, Worried
Item
Has your family worried about your usage of these?
boolean
C0220806 (UMLS CUI [1,1])
C0015576 (UMLS CUI [1,2])
C0233481 (UMLS CUI [1,3])
C0015576 (UMLS CUI [1,2])
C0233481 (UMLS CUI [1,3])
Chemicals, Family, Worried
Item
Has your family worried about your usage of these? - Describe
text
C0220806 (UMLS CUI [1,1])
C0015576 (UMLS CUI [1,2])
C0233481 (UMLS CUI [1,3])
C0015576 (UMLS CUI [1,2])
C0233481 (UMLS CUI [1,3])
Future, Changing, Expected
Item
What changes do you expect in your future?- Describe
text
C0016884 (UMLS CUI [1,1])
C0392747 (UMLS CUI [1,2])
C1517001 (UMLS CUI [1,3])
C0392747 (UMLS CUI [1,2])
C1517001 (UMLS CUI [1,3])
Quality of fife, Satisfaction
Item
Overall, how satisfied are you with your present quality of life? - Describe
text
C0034380 (UMLS CUI [1,1])
C0242428 (UMLS CUI [1,2])
C0242428 (UMLS CUI [1,2])
Item
Please rate your overall level of concern regarding your ability to cope or manage your pain (0-10; 0= no concern, 10 = greatest concern) - Interviewer
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding your ability to cope or manage your pain (0-10; 0= no concern, 10 = greatest concern) - Interviewer
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
Please rate your overall level of concern regarding your ability to cope or manage your pain (0-10; 0= no concern, 10 = greatest concern) - Patient
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding your ability to cope or manage your pain (0-10; 0= no concern, 10 = greatest concern) - Patient
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)
Item
Please rate your overall level of concern regarding your ability to cope or manage your pain (0-10; 0= no concern, 10 = greatest concern) - Significant Other
text
C0030193 (UMLS CUI [1,1])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
C1455743 (UMLS CUI [1,2])
C0009967 (UMLS CUI [1,3])
Code List
Please rate your overall level of concern regarding your ability to cope or manage your pain (0-10; 0= no concern, 10 = greatest concern) - Significant Other
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 (11)