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Chronic pain questionnaire
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CHRONIC PAIN ACCEPTANCE QUESTIONNAIRE 

Below are some statements. Please rate how each statement applies to your relationship with your pain. Add all the scores together to get your total score. The higher the score, the more likely it is that you are suffering from chronic pain and would benefit from our training course. Use the following scale:

0

Never

True

1

Very

Rarely

True

2

Seldom

True

3

Sometimes True

4

Often

True

5

Almost

Always

True

6

Always

True


Activity engagement statements

_____ 1. I am letting my pain get in the way of my life.

_____ 2. My life is generally bad due to my pain  

_____ 3. It’s not OK to experience my pain.  

_____ 4. It’s necessary for me to control my pain for my life to be good.  

_____ 5. I am not living a normal life because of my pain.  

_____ 6. I don’t do many things even when I feel pain.  

_____ 7. I do not lead a full life because of my pain.  

_____ 8. Controlling my pain is more important than any other things in my life.  

_____ 9. Due to my pain, I can’t stick to certain goals in my life.  

_____ 10. When my pain increases, I can’t take care of my other responsibilities.  

_____ 11. I have to change my pain to get on with my life.  

Pain willingness statements

_____ 12. I would sacrifice important other things in my life to manage my pain better.  

_____ 13. I need to find ways to reduce my pain.  

_____ 14. My thoughts and feelings about pain must change before I can make other big changes in my life.  

_____ 15. Keeping my pain level under control takes priority whenever I’m doing  something.  

_____ 16. Before I can make any serious plans, I have to get some control over my pain.  

_____ 17. I will have better control over my life if I can control my negative thoughts  about pain.  

_____ 18. I avoid putting myself in situations and doing activities where my pain might increase.  

_____ 19. My worries and fears about what pain will do to me are true.  

_____ 20. I struggle to do things when I am in pain.