Defense and Veterans Pain Rating Scale

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DOD/VA Pain Supplemental Questions

For clinicians to evaluate the biopsychosocial impact of pain.

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1. Mark the number that describes how, during the past 24 hours, pain has interfered with your usual ACTIVITY: *

2. Mark the number that describes how, during the past 24 hours, pain has interfered with your SLEEP: *

3. Mark the number that describes how, during the past 24 hours, pain has affected your MOOD: *

4. Mark the number that describes how, during the past 24 hours, pain has contributed to your STRESS: *

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25909 Pala Ste. 190