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PCS Questionnaire


Everyone experiences painful situations at some point in their lives. Such experiences may include headaches, tooth pain, joint or muscle pain. People are often exposed to situations that may cause pain such as illness, injury, dental procedures or surgery.

We are interested in the types of thoughts and feeling that you have when you are in pain. Listed below are thirteen statements describing different thoughts and feelings that may be associated with pain. Using the scale, please indicate the degree to which you have these thoughts and feelings when you are…
Name*
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Not at allTo a slight degreeTo a moderate degreeTo a great degreeAll the time
Consent*
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