Dr. Payne’s Questionnaire

I’ve been seeing a pain doctor. for about the last year now and she has been of great help to me. I didn’t even know they had doctors whose specialty was pain but she has a very busy office and I think that others may be in worse pain than I am. Of course that was before I started to take the medication. It’s pretty strong stuff so she makes sure that I see her at least once every three months so that neither one of us lands up in the big house for drug dealing or possession. I like to call my pain Dr., Dr.Payne. Never to her face, of course, but just in general when I’m talking about her. She’s actually a very good doctor so I shouldn’t be making fun of her and I’m sure the gods will punish me in one way or other.

 

I am entering a form below that Dr. Payne gave me before I became her patient and I thought it might be of interest to you in finding questions to ask your Dr. or in finding a doctor to help you deal with pain. Some of the questions I actually find funny but then you be the judge. Check out question number three.

 

http://www.thepottymouthbook.com/

The following questions are given to patients who are on or being considered for

medication for their pain. Please answer each question as honestly as possible.

There are no right or wrong answers.

 

NEVER

 

 

SELDOM

 

 

SOMETIMES

 

 

OFTEN

 

 

VERY OFTEN

 

 

0

1

2

3

4

1. How often do you have mood swings?

º

º

X

º

º

2. How often have you felt a need for higher doses of medication to treat your pain?

º

º

º

X

º

3. How often have you felt impatient with your doctors?

X

º

º

º

º

4. How often have you felt that things are just too overwhelming that you can’t handle them?

º

X

º

º

º

5. How often is there tension in the home?

º

X

º

º

º

6. How often have you counted you pain pills to see how many are remaining?

X

º

º

º

º

7. How often have you been concerned that people will judge you for taking pain medication?

X

º

º

º

º

8. How often do you feel bored?

º

º

X

º

º

9. How often have you taken more pain medication than you were supposed to?

º

º

X

º

º

10. How often have you worried about being left alone?

X

º

º

º

º

11. How often have you felt a craving for medication?

X

º

º

º

º

12. How often have others expressed concern over your use of medication?

X

º

º

º

º

13. How often have any of your close friends had a problem with alcohol or drugs?

X

º

º

º

º

14. How often have others told you that you had a bad temper?

X

º

º

º

º

15. How often have you felt consumed by the need to get pain medication?

X

º

º

º

º

16. How often have you run out of pain medication early?

º

X

º

º

º

17. How often have others kept you from getting what you deserve?

X

º

º

º

º

18. How often, in your lifetime, have you had legal problems or been arrested?

X

º

º

º

º

 

 

 

 

 

NEVER

 

 

SELDOM

 

 

SOMETIMES

 

 

OFTEN

 

 

VERY OFTEN

 

 

0

1

2

3

4

19. How often have you attended an AA or NA meeting?

X

º

º

º

º

20. How often have you been in an argument that was so out of control that someone got hurt?

X

º

º

º

º

21. How often have you been sexually abused?

X

º

º

º

º

22. How often have others suggested that you have a drug or alcohol problem?

X

º

º

º

º

23. How often have you have to borrow pain medications from your friends or family?

X

º

º

º

º

24. How often have you been treated for an alcohol or drug problem?

X

º

º

º

º

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