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1 forms
  1. StudyEvent: Brief Pain Inventory
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
RegistrationStep
Item
Registration Step
text
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
ECOGProtocolNumber
Item
ECOG Protocol Number
text
ECOGProtocolNumber
Item
ECOG Protocol Number
text
ECOGPatientID
Item
ECOG Patient ID
text
ECOGPatientID
Item
ECOG Patient ID
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
Throughoutourlives,mostofushavehadpainfromtimetotime(suchasminorheadaches,sprains,andtoothaches).Haveyouhadpainotherthantheseeverydaykindsofpaintoday?
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?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours.
text
CL.2
Code List
Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Please rate your pain by circling the one number that best describes your pain at its least in the last 24 hours.
text
CL.3
Code List
Please rate your pain by circling the one number that best describes your pain at its least in the last 24 hours.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Please rate your pain by circling the one number that best describes your pain on the average.
text
CL.4
Code List
Please rate your pain by circling the one number that best describes your pain on the average.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Please rate your pain by circling the one number that tells how much pain you have right now.
text
CL.5
Code List
Please rate your pain by circling the one number that tells how much pain you have right now.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Whattreatmentsormedicationsareyoureceivingforyourpain?
Item
What treatments or medications are you receiving for your pain?
text
Item
In the last 24 hours, how much relief have pain treatments or medications provided? (Please circle the one percentage that most shows how much relief you have received.)
text
CL.6
Code List
In the last 24 hours, how much relief have pain treatments or medications provided? (Please circle the one percentage that most shows how much relief you have received.)
CL Item
10% (10%)
CL Item
20% (20%)
CL Item
0.3 (0.3)
CL Item
0.4 (0.4)
CL Item
50% (50%)
CL Item
60% (60%)
CL Item
70% (70%)
CL Item
80% (80%)
CL Item
0.9 (0.9)
CL Item
100% (100%)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your general activity.
text
CL.7
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your general activity.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your mood.
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0026516 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.8
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your mood.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your walking ability.
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0080331 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.9
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your walking ability.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your normal walk.
text
CL.10
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your normal walk.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your relations with other people.
text
CL.11
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your relations with other people.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your sleep.
text
CL.12
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your sleep.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your enjoyment of life.
text
CL.13
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your enjoyment of life.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item Group
Ccrr Module For Brief Pain Inventory
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