No Instruction available.

  1. StudyEvent: USMCI 8214/Z6091: Brief Pain Inventory (Short Form)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
Patient Study ID
Item
Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Number
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
ProtocolUnitedStatesMilitaryCancerInstituteIdentifierNumber
Item
Protocol No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C68638 (NCI Thesaurus Property-2)
C0026126 (UMLS 2011AA Property-2)
Item Group
Brief Pain Assessment
QualityofLifeUnusualPainAssessmentInd-2
Item
Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains, and toothaches). Have you had pain other than these everyday kinds of pain today? (1.)
boolean
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property-2)
C1516048 (UMLS 2011AA Property-2)
C77967 (NCI Thesaurus Property-3)
C2700116 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
WorstPainAnatomicDorsalLocationText
Item
Put an X on the area that hurts the most (Front)
text
C3303 (NCI Thesaurus ObjectClass)
C0030193 (UMLS 2011AA ObjectClass)
C25719 (NCI Thesaurus ObjectClass-2)
C1522166 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25421 (NCI Thesaurus Property-2)
C0002808 (UMLS 2011AA Property-2)
C45874 (NCI Thesaurus Property-3)
C0205095 (UMLS 2011AA Property-3)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
WorstPainAnatomicVentralLocationText
Item
Put an X on the area that hurts the most (Back)
text
C3303 (NCI Thesaurus ObjectClass)
C0030193 (UMLS 2011AA ObjectClass)
C25719 (NCI Thesaurus ObjectClass-2)
C1522166 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25421 (NCI Thesaurus Property-2)
C0002808 (UMLS 2011AA Property-2)
C45875 (NCI Thesaurus Property-3)
C1704448 (UMLS 2011AA Property-3)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
Item
Please rate your pain by marking the box beside the number that best describes your pain at its WORST in the past 24 hours. (3.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25719 (NCI Thesaurus Property-2)
C1522166 (UMLS 2011AA Property-2)
Code List
Please rate your pain by marking the box beside the number that best describes your pain at its WORST in the past 24 hours. (3.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Please rate your pain by marking the box beside the number that best describes your pain at its LEAST in the past 24 hours. (4.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C61422 (NCI Thesaurus Property-2)
C0547044 (UMLS 2011AA Property-2)
Code List
Please rate your pain by marking the box beside the number that best describes your pain at its LEAST in the past 24 hours. (4.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Please rate your pain by marking the box beside the number that best describes your pain on the AVERAGE. (5.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C37917 (NCI Thesaurus Property-2)
C1510992 (UMLS 2011AA Property-2)
Code List
Please rate your pain by marking the box beside the number that best describes your pain on the AVERAGE. (5.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Please rate your pain by marking the box beside the number that tells how much pain you have RIGHT NOW. (6.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
Code List
Please rate your pain by marking the box beside the number that tells how much pain you have RIGHT NOW. (6.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
PainMedicationCurrentAdministrationText
Item
What treatments or medications are you receiving for your pain
text
C3303 (NCI Thesaurus ObjectClass)
C0030193 (UMLS 2011AA ObjectClass)
C459 (NCI Thesaurus ObjectClass-2)
C0013227 (UMLS 2011AA ObjectClass-2)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
Item
In the past 24 hours, how much RELIEF have pain treatments or medications provided? (Please select the percentage that shows how much.)
text
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C61497 (NCI Thesaurus Property-3)
C1880019 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
In the past 24 hours, how much RELIEF have pain treatments or medications provided? (Please select the percentage that shows how much.)
CL Item
0% (0%)
CL Item
10% (10%)
CL Item
100% (100%)
CL Item
20% (20%)
CL Item
30% (30%)
CL Item
40% (40%)
CL Item
50% (50%)
CL Item
60% (60%)
CL Item
70% (70%)
CL Item
80% (80%)
CL Item
90% (90%)
Item Group
Assessment of Patient Activity
Item
General Activity (9.)
text
C0001288 (NCI Metathesaurus ObjectClass)
C63764 (NCI Thesaurus ObjectClass)
C0205246 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
General Activity (9.)
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Mood (10.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Mood (10.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Walking ability (11.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Walking ability (11.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Normal work (includes both work outside the home and housework)
text
C14165 (NCI Thesaurus ObjectClass)
C0205307 (UMLS 2011AA ObjectClass)
C0043227 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Normal work (includes both work outside the home and housework)
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Relations with other people (13.)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0021797 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Relations with other people (13.)
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Sleep (14.)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0037313 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Sleep (14.)
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Enjoyment of life
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
CL196329 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Enjoyment of life
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial