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Click ‘Get Form’ to open the brief pain inventory short form in the editor.
Begin by entering the date, study name, protocol number, and subject's initials at the top of the form. This information is essential for tracking and identifying your submission.
For question 1, indicate whether you have experienced any pain today by selecting 'Yes' or 'No'.
In question 2, use the diagram provided to shade areas where you feel pain and mark an 'X' on the spot that hurts the most.
Questions 3 to 6 require you to rate your pain levels at their worst, least, average, and current state. Simply mark the box next to the number that best represents your experience on a scale from 0 (no pain) to 10 (pain as bad as you can imagine).
For question 7, list any treatments or medications you are currently receiving for your pain.
In question 8, indicate how much relief these treatments have provided in the last 24 hours by marking a percentage from 0% (no relief) to 100% (complete relief).
Finally, for questions 9A through 9G, rate how much pain has interfered with various aspects of your life over the past day using a scale from 0 (does not interfere) to 10 (completely interferes).
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A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe.
What is the Brief Pain Inventory short form?
The Brief Pain Inventory - Short Form (BPI-sf) is a 9 item self-administered questionnaire used to evaluate the severity of a patients pain and the impact of this pain on the patients daily functioning.
What does BPI measure?
The Brief Pain Inventory. The Brief Pain Inventory (BPI) rapidly assesses the severity of pain and its impact on functioning. The BPI has been translated into dozens of languages, and it is widely used in both research and clinical settings.
What is the brief pain inventory TAC?
Brief Pain Inventory (BPI) Monitors change in both pain intensity and pain interference with many aspects of a persons life throughout a treatment program. (MDC = 1/10, MCID = 2+/10) This is sensitive to the initial severity and the individual circumstances.
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Have you had pain other than these everyday kinds of pain today? Brief Pain Inventory (Short Form). 2. On the diagram, shade in the areas where you feel pain.
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