Name:_________________________________________________   Date:_________
	Short-Form McGill Pain Questionnaire:
	I. Pain Rating Index (PRI)
	The words below describe average pain.  Place a check mark (√) in the column
	that represents the degree to which you feel that type of pain.
			None		Mild		Moderate		Severe
	1. Throbbing	0		1		2		3
	2. Shooting	0		1		2		3
	3. Stabbing	0		1		2		3
	4. Sharp	0		1		2		3
	5. Cramping	0		1		2		3
	6. Gnawing	0		1		2		3
	7. Hot-Burning	0		1		2		3
	8. Aching	0		1		2		3
	9. Heavy	0		1		2		3
	10. Tender	0		1		2		3
	11. Splitting	0		1		2		3
	12. Tiring-Exhausting	0		1		2		3
	13. Sickening	0		1		2		3
	14. Fearful	0		1		2		3
	15. Punishing-Cruel	0		1		2		3
	II. Present Pain Intensity (PPI)--Visual Analog Scale (VAS). Tick along scale below for pain:
	0        1        2        3        4        5        6        7        8        9        10
	III. Evaluative overall intensity of total pain experience. Place a (√) in the appropriate column:
		0	No Pain
		1	Mild
		2	Discomforting
		3	Distressing
		4	Horrible
		5	Excruciating