Pain Disability Index

Pain Disability Index 2023-01-25T16:20:23-07:00

Pain Disability Index & Headache Disability Questionnaire (PDQ)

Instructions: These questions ask your views about how your pain now affects how you function in everyday activities. Please answer every question and mark the ONE number on EACH scale that best describes how you feel.

    • Work normally
    • Unable to work at all
    • Take care of myself completely
    • Need help with all my personal care
    • Travel anywhere I like
    • Only travel to see doctors
    • No problems
    • Cannot sit / stand at all
    • No problems
    • Cannot do at all
    • No problems
    • Cannot do at all
    • No problems
    • Cannot walk / run at all
    • No decline
    • Lost all income
    • No medication needed
    • On pain medication throughout the day
    • Never see doctors
    • See doctors weekly
    • No problem
    • Never see them
    • No interference
    • Total interference
    • Never need help
    • Need help all the time
    • No depression / tensions
    • Severe depression / tension
    • No problems
    • Severe problems
  • Headache Disability Questionnaire (HDQ)

    Please answer the following questions about ALL of the headaches you have had over the last 3 months. Select your answer in the box next to each question. Select Zero if you did not have the activity in the last 3 months. Please take the completed form to your healthcare professional.
  • Please enter a number greater than or equal to 0.
  • Please enter a number greater than or equal to 0.
  • Please enter a number greater than or equal to 0.
  • Please enter a number greater than or equal to 0.
  • Please enter a number greater than or equal to 0.
  • Please enter a number greater than or equal to 0.
    • No pain at all
    • Pain as bad as it can be
  • Date Format: MM slash DD slash YYYY

Have questions for us?

    Due to increased patient care needs, Dr. Friesen is currently scheduling New Patient Jaw examinations in 9-12 months. Motor Vehicle examinations are scheduling in 8 weeks. All new patients can be added to Dr. Friesen's waitlist. For patients with urgent or acute care needs, please contact our office directly at 780.463.3616
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