I am entering a form below that Dr. Payne gave me before I became her patient and I thought it might be of interest to you in finding questions to ask your Dr. or in finding a doctor to help you deal with pain. Some of the questions I actually find funny but then you be the judge. Check out question number three.
http://www.thepottymouthbook.com/
The following questions are given to patients
who are on or being considered for
medication for their pain. Please answer each question
as honestly as possible.
There are no right or wrong answers.
|
NEVER
|
SELDOM
|
SOMETIMES
|
OFTEN
|
VERY OFTEN
|
0
|
1
|
2
|
3
|
4
|
|
1. How often do you have mood swings?
|
º
|
º
|
X
|
º
|
º
|
2. How often have you felt a need for higher
doses of medication to treat your pain?
|
º
|
º
|
º
|
X
|
º
|
3. How often have you felt impatient with
your doctors?
|
X
|
º
|
º
|
º
|
º
|
4. How often have you felt that things are
just too overwhelming that you can't handle them?
|
º
|
X
|
º
|
º
|
º
|
5. How often is there tension in the home?
|
º
|
X
|
º
|
º
|
º
|
6. How often have you counted you pain pills
to see how many are remaining?
|
X
|
º
|
º
|
º
|
º
|
7. How often have you been concerned that
people will judge you for taking pain medication?
|
X
|
º
|
º
|
º
|
º
|
8. How often do you feel bored?
|
º
|
º
|
X
|
º
|
º
|
9. How often have you taken more pain
medication than you were supposed to?
|
º
|
º
|
X
|
º
|
º
|
10. How often have you worried about being
left alone?
|
X
|
º
|
º
|
º
|
º
|
11. How often have you felt a craving for
medication?
|
X
|
º
|
º
|
º
|
º
|
12. How often have others expressed concern
over your use of medication?
|
X
|
º
|
º
|
º
|
º
|
13. How often have any of your close friends
had a problem with alcohol or drugs?
|
X
|
º
|
º
|
º
|
º
|
14. How often have others told you that you
had a bad temper?
|
X
|
º
|
º
|
º
|
º
|
15. How often have you felt consumed by the
need to get pain medication?
|
X
|
º
|
º
|
º
|
º
|
16. How often have you run out of pain medication
early?
|
º
|
X
|
º
|
º
|
º
|
17. How often have others kept you from
getting what you deserve?
|
X
|
º
|
º
|
º
|
º
|
18. How often, in your lifetime, have you had
legal problems or been arrested?
|
X
|
º
|
º
|
º
|
º
|
NEVER
|
SELDOM
|
SOMETIMES
|
OFTEN
|
VERY OFTEN
|
|
0
|
1
|
2
|
3
|
4
|
|
19. How often have you attended an AA or NA
meeting?
|
X
|
º
|
º
|
º
|
º
|
20. How often have you been in an argument
that was so out of control that someone got hurt?
|
X
|
º
|
º
|
º
|
º
|
21. How often have you been sexually abused?
|
X
|
º
|
º
|
º
|
º
|
22. How often have others suggested that you
have a drug or alcohol problem?
|
X
|
º
|
º
|
º
|
º
|
23. How often have you have to borrow pain
medications from your friends or family?
|
X
|
º
|
º
|
º
|
º
|
24. How often have you been treated for an
alcohol or drug problem?
|
X
|
º
|
º
|
º
|
º
|