This is a self-report questionnaire designed to predict aberrant medication-related behaviors among persons with chronic pain.
- How often do you have mood swings?
- How often have you felt the need for higher doses of medication to treat your pain?
- Have often have you felt impatient with your doctors?
- How often have you felt that things are just too overwhelming that you cannot handle them?
- How often is there tension in the home?
- How often have you counted pain pills to see how many are remaining?
- How Often have you been concerned that people will judge you for taking pain medication?
- How often do you feel bored?
- How often have you taken more pain medication than you were supposed to?
- How often have you worried about being left alone?
- How often have you felt a craving for medication?
- How often have others expressed concern over your use of medication?
- How often have any of your close friends had a problem with alcohol or drugs?
- How often have others told you tha tyou have a bad temper?
- How often have you felt consumed by the need to get pain medication?
- How often have you run out of pain medication early?
- How often have others kept you from getting what you deserve?
- How often, in your lifetime, have you had legal problems or been arrested?
- How often have attended an NA or AA meeting?
- How often have you been in an argument that was so out of control that someone got hurt?
- How often have you been sexually abused?
- How often have others suggested that you have a drug or alcohol problem?
- How often have you had to borrow pain medications from your family or friends?
- How often have you been treated for an alcohol or drug problem?
** From the Journal of Addiction Medicine, Vol 3, Num 2, June 2009**