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Total # of Questions: 21

PROMIS pediatric item bank - pain interference - version 2.0 [89935-1]

Date Done

Time Done

Where Done

Comment

Name

Value

Units

In the past 7 days - I felt angry when I had pain [62142-5]

In the past 7 days - I had trouble doing schoolwork when I had pain [62143-3]

In the past 7 days - I had trouble sleeping when I had pain [62144-1]

In the past 7 days - It was hard for me to pay attention when I had pain [62154-0]

In the past 7 days - It was hard for me to run when I had pain [62148-2]

In the past 7 days - It was hard for me to walk one block when I had pain [62149-0]

In the past 7 days - It was hard to have fun when I had pain [62152-4]

In the past 7 days - It was hard to stay standing when I had pain [62153-2]

In the past 7 days - I hurt a lot [62145-8]

In the past 7 days - I hurt all over my body [62147-4]

In the past 7 days - I missed school when I had pain [62150-8]

In the past 7 days - It was hard for me to remember things when I had pain [62146-6]

In the past 7 days - It was hard to get along with other people when I had pain. [62151-6]

In the past 7 days - It was hard for me to be away from home because I had pain. [78162-5]

In the past 7 days - It was hard to have fun with friends because I was in pain. [78163-3]

In the past 7 days - I needed help walking when I was in pain. [78164-1]

In the past 7 days - I walked carefully when I was in pain. [78165-8]

In the past 7 days - I had so much pain I had to stop what I was doing [89934-4]

In the past 7 days - My pain was so bad that I needed to take medicine to treat it. [78166-6]

In the past 7 days - It was hard to do things with my family because I had pain. [78167-4]

PROMIS pediatric pain interference - version 2.0 T-score [89936-9]

PLEASE WAIT