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Pain Management Clinic
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Pain Management Team
Services
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Physical Therapy
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Pain Psychology
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Pain Management Procedures
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Spinal Injections
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Medial Branch Blocks
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Pulsed Radiofrequency Neurotomy
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Spinal Cord Stimulation Trial
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Spinal Cord and Subcutaneous Stimulation Implantation
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Radiofrequency Neurotomy for Facet Joint Pain
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Chemical Lumbar Sympathectomy
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Epidural Steroid Injections
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Protein Rich Plasma/ Autologous Blood injections
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Lumbar Sympathectomy
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Stellate Ganglion Block
Pain Types
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Chronic Pain
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Spinal Pain / Back Pain
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Neuropathic Pain
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Cancer Pain
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Acute Pain (surgical pain)
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Post-Surgical Pain
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Pain in the Elderly
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Pelvic Pain
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Other Pain Syndromes
Resources
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News
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Forms
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Patient Information Form
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Brief Pain Inventory
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Pain Catastrophizing Scale
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Tampa Scale for Kinesiophobia
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DASS
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Pain Self Efficacy Questionnaire
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RMDQ 2011
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Psychometric Data
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Pain Stimulation Patients
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Links
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Video Resources
Contact Us
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Newcastle Pain Management Clinic
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Maitland Pain Management Clinic
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Singleton Pain Management Clinic
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Nelson Bay Pain Management Clinic
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Gosford Pain Management Clinic
Tampa Scale for Kinesiophobia
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Forms
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Tampa Scale for Kinesiophobia
Tampa Scale for Kinesiophobia
Name
*
Date of Birth
*
Rating
1
2
3
4
Meaning
Strongly agree
Disagree
Agree
Strongly agree
I'm afraid that I might injury myself if I exercise
*
1
2
3
4
If I were to try to overcome it, my pain would increase
*
1
2
3
4
My body is telling me I have something dangerously wrong
*
1
2
3
4
My pain would probably be relieved if I were to exercise
*
1
2
3
4
People aren't taking my medical condition seriously enough
*
1
2
3
4
My accident has put my body at risk for the rest of my life
*
1
2
3
4
Pain always means I have injured my body
*
1
2
3
4
Just because something aggravates my pain does not mean it is dangerous
*
1
2
3
4
I'm afraid I might injure myself accidentally
*
1
2
3
4
Simply being careful that I do not make any unnecessary movements is the safest thing I can do to prevent my pain from worsening
*
1
2
3
4
I wouldn't have this much pain if there weren't something potentially dangerous going on in my body
*
1
2
3
4
Although my condition is painful, I would be better off if I were physically active
*
1
2
3
4
Pain lets me know when to stop exercising so that I don't injure myself
*
1
2
3
4
It's really not safe for a person with a condition like mine to be physically active
*
1
2
3
4
I can't do all the things normal people do because it's too easy for me to get injured
*
1
2
3
4
Even though something is causing me a lot of pain, I don't think it's actually dangerous
*
1
2
3
4
No one should have to exercise when he/ she is in pain
*
1
2
3
4
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