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Mc gill pain questionnaire short form

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Mc gill pain questionnaire short form

  1. 1. Appendix IV (i) SHORT FORM McGILL PAIN QUESTIONNAIRE and PAIN DIAGRAM (Reproduced with permission of author © Dr. Ron Melzack, for publication and distribution) Date: ______________________________________ Name: _____________________________________Check the column to indicate the level of yourpain for each word, or leave blank if it does notapply to you. Mild Moderate Severe1 Throbbing _____ _____ _____2 Shooting _____ _____ _____3 Stabbing _____ _____ _____4 Sharp _____ _____ _____5 Cramping _____ _____ _____6 Gnawing _____ _____ _____7 Hot-burning _____ _____ _____8 Aching _____ _____ _____9 Heavy _____ _____ _____10 Tender _____ _____ _____11 Splitting _____ _____ _____12 Tiring-Exhausting_____ _____ _____13 Sickening _____ _____ _____14 Fearful _____ _____ _____15 Cruel-Punishing _____ _____Indicate on this line how bad your pain is—at the left end of line means no pain at all, at right endmeans worst pain possible. No ________________________________________________ Worst Possible Pain Pain S /33 A /12 VAS /10

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