Pain Self Efficacy Questionnaire

Please allow 20 minutes to complete this questionnaire below in its entirety.

If you have any questions, please phone our rooms on (02) 4923 8900.

Name(Required)

Date of Birth(Required)

DD slash MM slash YYYY

Please rate how confident you are that you can do the following things at present, despite the pain.

To indicate your answer choose one of the numbers on the scale under each item, where 0 = not at all confident and 6 = completely confident.

I can enjoy things, despite the pain(Required)

I can do most of the household chores (eg. tidying-up, washing dishes etc), despite the pain(Required)

I can socialise with my friends or family members as often as I used to do, despite the pain(Required)

I can cope with my pain in most situations(Required)

I can do some form of work, despite the pain. ("work" includes housework, paid and unpaid work)(Required)

I can still do many of the things I enjoy doing, such as hobbies or leisure activity, despite pain.(Required)

I can cope with my pain without medication(Required)

I can still accomplish most of my goals in life, despite the pain(Required)

I can live normal lifestyle, despite the pain(Required)

I can gradually become more active, despite the pain(Required)

Hidden

Total