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PAIN-MANAGEMENT----PSYCH-SYMPTOMS QUESTIONNAIRE

Scores Will Be:

0 for No
1 for Yes

TENSION

SLEEPLESSNESS

ANXIETY

DEPRESSION

TIRED/FATIGUE

FEELING OF HELPLESSNESS

NERVOUS

LOSS OF INTEREST IN LIFE

WORRY ABOUT FUTURE, HEALTH AND CAREER

PREOCCUPATION WITH HAPPENNINGS AT WORK

THOUGHTS OF SUCIDE

FEARS OF DEATH OR DYING

VERBAL ABUSE AT WORK

HARASSMENT BY SUPERVISOR

HARRASSMENT BY CO-WORKER

CONFUSED THOUGHTS

POOR CONCENTRATION

ARE YOU ANGRY

EXHAUSTION

CRYING SPELLS

MOOD CHANGES

POOR SELF ESTEEM

IRRITABILITY

WITHDRAWAL FROM FAMILY & FRIENDS

LOSS OF INTEREST IN USUAL ACITIVITIES

FEELINGS OF DISCRIMINATION

PHYSICAL PAIN

SELF DOUBT DUE TO PHYSICAL INJURY

FRUSTRAION

OTHER