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Pain Questionnaire For Social Security


If you answer "yes" to the question about pain in the Disability Report SSA-3368-BK, your answer may trigger this questionnaire.

Pain, like fatigue, is a subjective symptom that cannot be measured in the lab and is not generally observable by a medical practitioner.

General advice when completing the Pain Questionnaire is to be very specific in your answers. Describe how pain has affected your daily routine, for example: if you can no longer take walks or participate in sports because of pain. If you have been completing a Symptoms Diary, don't forget to consult it before completing the form.

The Pain Questionnaire asks very specific questions about your pain such as:

  • Where is it located?
  • Is the pain a throb, ache, sharp, stabbing etc?
  • How frequent is the pain?
  • Does the pain spread or move?
  • Does lying down or resting or medication relieve the pain? If so, how successfully and for how long?
  • How does the pain impact on your daily activities and your ability to concentrate and think clearly? (For a list of daily activities to help jog your memory, see Daily Activities.)
  • Do you wear or use any device to relieve the pain or its effects? Be specific and describe everything you do to relieve pain, whether it's cool baths, warm baths, staying in a dark room, listening to music, loose clothing, sunglasses to cut down on glare or whatever.

Even if it is in the medical records Social Security has, include any treatment you have tried for pain such as acupuncture, chiropractic treatment, massage or meditation.

Before completing a Pain Questionnaire, consider reading Tips When Completing All Questionnaires Concerning Your Medical Condition.

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