ENFA Pan European Survey 2015
1. Please enter the country you live in and answer the questions about your fibromyalgia experience in this country. *
Your answer
2. What is your Gender? [single choice] *
3. Please select your Age Group when you first experienced symptoms [single choice] *
4. How long have you been diagnosed with Fibromyalgia by a member of the medical *
Approximately how long after your first visit were you given a definite diagnosis of Fibromyalgia? [single choice] *
6. Who diagnosed you? *
7. Were you satisfied with the overall way in which your Fibromyalgia was diagnosed? *
8. If your doctor explained what Fibroymalgia is, how would you rate their explanation? *
9. Have you attended a specialist service for your fibromyalgia? [Multiple answers] *
Required
10. Do you feel that your condition is monitored closely enough by the people in charge of your care? [single choice]
11. Would you rate the overall treatment that you have received from the medical profession regarding the management of your Fibromyalgia as: [Single choice] *
12. How would you rate each of the following in relation to the management of your *
1 = poor to 9 = excellent
1
2
3
4
5
6
7
8
9
N/A
Support from the people in charge of your care
Empathy/understanding shown by the people in charge of your care
Communication between yourself and the people in charge of your care
Understanding of your condition by the people in charge of your care
Interest shown by the people in charge of your care
13. Has pain had a direct impact on your quality of life? [Single choice] *
14. Who is treating your pain? [Multiple answers]
Please rate how you have reacted to the following medications you have taken for your pain *
benefit
no benefit
adverse reaction
does not apply
Amitryptiline
Fluoxetine
Duloxetine
Milnacipran
Pregabalin
Paracetamol
Co-codamol
Co-dydramol
LDN (Low Dose Naltrexone)
Pramipaxiole
16. Please rate any of the following non-drug treatments you have used to control your pain. *
benefit
no benefit
adverse reaction
does not apply
Acupuncture
TENS
Hydrotherapy/water exercise
Psychological therapy
Meditation
Relaxation
Physiotherapy
Occupational therapy
Massage
Exercise programme
Please tick the boxes that show how much you had to spend if the treatment was not provided through your national health system. *
0
1 - 50
51 - 100
101 - 200
201 - 300
301 - 400
401-500
501 - 1000
over 1000
Acupuncture
TENS
Hydrotherapy/water exercise
Psychological therapy
Meditation
Relaxation
Physiotherapy
Occupational therapy
Massage
Exercise progarmmes
Other
17. How would you rate the way that your pain is being managed?
very poor
excellent
18. Has your Fibromyalgia affected your ability to work? [single choice] *
If no or not applicable go to question 20
19. In what way(s) has your Fibromyalgia affected your ability to work? [Multiple answers]
20. Do you receive any state (Government) benefits as a result of your Fibromyalgia? *
Please rate the following items to show what impact your Fibromyalgia has.
1 = no impact 9 = severe impact
1
2
3
4
5
6
7
8
9
Looking completely normal from the outside – no visible signs of disease
Having to regularly visit the doctor / hospital(s)
Having to explain to other people what your condition is and how it affects you
Side-effects of the medication
The number of pills that you have to take
The lack of a definitive diagnosis (not knowing what the underlying cause is)
Disrupted sleep pattern
The pain
Fatigue and cognitive dysfunction (fibrofog)
Depression / Anxiety
The lack of a long-term prognosis (not knowing how it will affect you in the future)
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