calc pfizer pain

Neuropathic Pain Diagnostic Questionnaire

Please complete this questionnaire by checking one answer for each item in the four questions below.

  INTERVIEW OF THE PATIENT
  Question 1: Does the pain have one or more of the following characteristics?  
 
  YES NO
 1 – Burning
 2 – Painful cold
 3 – Electric shocks
 
  Question 2: Is the pain associated with one or more of the following symptoms in the same area?  
 
  YES NO
 4 – Tingling
 5 – Pins and Needles
 6 – Numbness
 7 – Itching
 
     

  EXAMINATION OF THE PATIENT
  Question 3: Is the pain located in an area where the physical examination may reveal one or more of the following characteristics?  
 
  YES NO
 8 – Touch Hypoaesthesia
 9 – Pricking Hypoaesthesia
 
  Question 4: In the painful area, can the pain be caused or increased by?  
 
  YES NO
 10 – Brushing ( for example: using a Von Frey hair brush )
 
     
 
     

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D. Bouhassira et al. Pain. 2005 Mar 114(1-2): 29-36.

Pfizer Pain Management

This information will be collected for educational purposes, however it will remain anonymous.