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  1. Click ‘Get Form’ to open the NIH Chronic Prostatitis Symptom Index in the editor.
  2. Begin by entering your name and the date at the top of the form. This personal information is essential for tracking your responses.
  3. In the 'Pain or Discomfort' section, answer each question regarding pain experienced in specific areas over the last week by selecting 'Yes' or 'No'. Use the provided scale to indicate frequency and intensity of pain.
  4. Proceed to the 'Urination' section. Here, you will assess sensations related to bladder emptying and frequency of urination. Again, use the scale provided for accurate responses.
  5. Next, evaluate how much your symptoms have impacted your daily activities and thoughts about them in the 'Impact of Symptoms' section. Select from options ranging from 'None' to 'A lot'.
  6. Finally, reflect on your quality of life with respect to your symptoms in the last week. Choose a response that best describes your feelings about living with these symptoms long-term.

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Pain severity categories results for NIH-CPSI item 4 (010 numerical rating scale for average pain) were mild, 03; moderate, 46; severe, 710; CPSI pain domain (021): mild, 07; moderate, 813; and severe, 1421.
Pain severity categories results for NIH-CPSI item 4 (0-10 numerical rating scale for average pain) were mild, 0-3; moderate, 4-6; severe, 7-10; CPSI pain domain (0-21): mild, 0-7; moderate, 8-13; and severe, 14-21.
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) Pain from CP/CPPS can last for weeks to months to years. This pain may also be due to the muscles in the pelvis. This is NOT an infection but symptoms may be like those in men with CBP.

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Pain severity categories results for NIH-CPSI item 4 (0-10 numerical rating scale for average pain) were mild, 0-3; moderate, 4-6; severe, 7-10; CPSI pain domain (0-21): mild, 0-7; moderate, 8-13; and severe, 14-21.
NIH-Chronic Prostatitis Symptom Index (NIH-CPSI)
The NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) is a commonly used 13-item questionnaire for the assessment of symptom severity in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). For each item, score ranges are 01 (6 items), 03 (2 items), 05 (3 items), 06 (1 item), and 010 (1 item).

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