RESEARCH STUDY: RELATIONSHIP BETWEEN PAIN AND SLEEP IN SPINAL CORD INJURY PATIENTS Pain perception : McGill Pain Questionnaire

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1 RESEARCH STUDY: RELATIONSHIP BETWEEN PAIN AND SLEEP IN SPINAL CORD INJURY PATIENTS Pain perception : McGill Pain Questionnaire Participants Name: Date: Time: PRI: S A E M PRI (TOTAL) PPI (1-10) (11-15) (16) (17-20) (1-20) Flickering 1. Jumping 1. Pricking 1. Sharp 2. Quivering 2. Flashing 2. Boring 2. Cutting 3. Pulsing 3. Shooting 3. Drilling 3. Lacerating 4. Throbbing 4. Stabbing 5. Beating 5. Lancinating 6. Pounding Pinching 1. Tugging 1. Hot 1. Tingling 2. Pressing 2. Pulling 2. Burning 2. Itching 3. Gnawing 3. Wrenching 3. Scalding 3. Smarting 4. Cramping 4. Searing 4. Stinging 5. Crushing Dull 1. Tender 1. Tiring 1. Sickening 2. Sore 2. Taut 2. Exhausting 2. Suffocating 3. Hurting 3. Rasping 4. Aching 4. Splitting 5. Heavy Fearful 1. Punishing 1. Wretched 1. Annoying 2. Frightful 2. Gruelling 2. Blinding 2. Troublesome 3. Terrifying 3. Cruel 3. Miserable 4. Vicious 4. Intense 5. Killing 5. Unbearable Spreading 1. Tight 1. Cool 1. Nagging 2. Radiating 2. Numb 2. Cold 2. Nauseating 3. Penetrating 3. Drawing 3. Freezing 3. Agonising 4. Piercing 4. Squeezing 4. Dreadful 5. Torturing 1

2 Present Pain Intensity (PPI) What was your previous most painful experience? People agree that the following 5 words represent pain in increasing intensity. They are: Mild Discomforting Distressing Horrible Excruciating To answer the questions below, write the number of the most appropriate word given above in the space provided: 1. Which word describes the worst pain you have ever felt? 2. Which word describes the worst toothache you have ever had? 3. Which word describes the worst headache you have ever had? 4. Which word describes the worst stomach-ache you have ever had? 5. Which would best describes your present pain? VAS PAIN RATING In your experience, how would you rate the pain you are currently feeling. No pain The worst pain I have ever felt In your life, how much pain have you had from illness and injury. None As much as anyone could have LOCATION OF SENSATION Where is your pain? (Please mark, on the drawings below, the areas where you feel pain. Put E if external, or I if internal, near the areas which you mark. Put EI if both external and internal. ALSO: if you have one or more areas which can trigger your pain when pressure is applied to them, mark each with an X). 2

3 RESEARCH STUDY: RELATIONSHIP BETWEEN PAIN AND SLEEP IN SPINAL CORD INJURY PATIENTS Brief Pain Inventory (Short form) Name Date 1. Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains, and toothaches). Have you had pain other than these everyday kinds of pain today? 1. Yes 2. No 2. On the diagram, shade in the areas where you feel pain. Put an X on the area that hurts the most 3. Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours. Pain as bad as you can imagine 4. Please rate your pain by circling the one number that best describes your pain at its least in the last 24 hours. Pain as bad as you can imagine 5. Please rate your pain by circling the one number that best describes your pain on the average 3

4 Pain as bad as you can imagine 6. Please rate your pain by circling the one number that tells how much pain you have right now. Pain as bad as you can imagine 7. What treatments or medications are you receiving for your pain? 8. In the last 24 hours, how much relief have pain treatments or medications provided? Please circle the one percentage that most shows how much relief you have received 0 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% No Relief Complete relief 9. Circle the one number that describes how, during the past 24 hours, pain has interfered with your: A. General Activity Does not interfere Completely interferes B. Mood Does not interfere Completely interferes C. Mobility Does not interfere Completely interferes D. Relations with other people Does not interfere Completely interferes 4

5 E. Sleep Does not interfere Completely interferes F. Enjoyment of life Does not interfere Completely interferes 1. Thinking about your own life and personal circumstances, how satisfied are you with your life as a whole in the past four weeks? Please use a scale ranging from 0 (completely dissatisfied) to 10 (completely satisfied). You can use 0 or 10 or any number in between. Completely dissatisfied Completely satisfied 2. How satisfied are you with your physical health in the past four weeks? Please use a scale ranging from 0 (completely dissatisfied) to 10 (completely satisfied). You can use 0 or 10 or any number in between. Completely dissatisfied Completely satisfied 3. How satisfied are you with your psychological health, emotions and mood in the past four weeks? Please use a scale ranging from 0 (completely dissatisfied) to 10 (completely satisfied). You can use 0 or 10 or any number in between. Completely dissatisfied Completely satisfied 5

6 RESEARCH STUDY: RELATIONSHIP BETWEEN PAIN AND SLEEP IN SPINAL CORD INJURY PATIENTS: PAIN CATASTROPHIZING SCALE Name Date 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 cause pain such as illness, injury, dental procedures or surgery. Instructions We are interested in the types of thoughts and feelings that you have when you are in pain. Listed below are 13 statements describing different thoughts and feelings that may be associated with pain. Using the following scale, please indicate the degree to which you have these thoughts and feelings when you are experiencing pain. RATING MEANING Not at all To a slight To a moderate To a great All the time degree degree degree When I m in pain.. Number Statement Rating 1 I worry all the time about whether the pain will end. 2 I feel I can t go on. 3 It s terrible and I think it s never going to get better. 4 It s awful and I feel that it overwhelms me. 5 I feel I can t stand it anymore. 6 I become afraid that the pain will get worse. 7 I keep thinking of other painful events. 8 I anxiously want the pain to go away. 9 I can t seem to keep it out of my mind. 10 I keep thinking about how much it hurts. 11 I keep thinking about how badly I want the pain to stop. 12 There s nothing I can do to reduce the intensity of the pain. 13 I wonder whether something serious may happen References Sullivan, M.J.L., Bishop, S., Pivik, J. (1995). The pain catastrophizing scale: development and validation. Psychological Assessment 7:

7 RESEARCH STUDY: RELATIONSHIP BETWEEN PAIN AND SLEEP IN SPINAL CORD INJURY PATIENTS NEUROPATHIC PAIN SCALE 1. Please use the scale below to tell us how intense your pain is. Place an X through the number that best describes the intensity of your pain. the most intense pain sensation imaginable 2. Please use the scale below to tell us how sharp your pain feels. Words used to describe sharp feelings include like a knife, like a spike, jabbing or like jolts. the sharpest sensation imaginable (like a knife) 3. Please use the scale below to tell us how hot your pain feels. Words used to describe very hot pain include burning and on fire the hottest sensation imaginable 4. Please use the scale below to tell us how dull your pain feels. Words used to describe very dull pain include like a dull toothache, dull pain, aching, and like a bruise the most dull sensation imaginable 5. Please use the scale below to tell us how cold your pain feels. Words used to describe very cold pain include like ice and freezing the most cold sensation imaginable 6. Please use the scale below to tell us how sensitive your skin is to light touch or clothing. Words used to describe sensitive skin include like sunburned skin and raw skin the most cold sensation imaginable 7. Please use the scale below to tell us how itchy your pain feels. Words used to describe itchy pain include like poison oak and like a mosquito bite. 7

8 the itchiest sensation imaginable 8. Which of the following best describes the time quality of your pain? Please check only one answer. ( ) I feel a background pain all of the time and occasional flare-ups (break-through pain) some of the time. Describe the background pain: Describe the flare-up (break through) pain: ( ) I feel a single type of pain all the time. Describe this pain: ( ) I feel a single type of pain only sometimes. Other times, I am pain free. Describe this occasional pain: 9. Now that you have told us the different physical aspects of your pain, the different type of sensations, we want you to tell us overall how unpleasant your pain is to you. Words used t describe very unpleasant pain include miserable and intolerable. Remember pain can have a low intensity but still feel extremely unpleasant, and some kinds of pain can have a high intensity but be very tolerable. With this scale, please tell us how unpleasant your pain feels the most unpleasant sensation imaginable 10. Lastly, we want you to give us an estimate of the severity of your deep pain versus your surface pain. We want you to rate each location of pain separately. We realize that it can be difficult to make these estimates, and most likely it will be a best guess, but please give us your best estimate How intense is your deep pain most intense deep pain sensation imaginable How intense is your surface pain most intense surface pain sensation imaginable 8

9 RESEARCH STUDY: RELATIONSHIP BETWEEN PAIN AND SLEEP IN SPINAL CORD INJURY PATIENTS PITTSBURGH INSOMINA RATING SCALE University of Pittsburgh School of Medicine, Department of Psychiatry, All rights reserved. Participants Name: Date: A. Overall sleep quality: Consider the quality of your sleep in the past 7 days. Then mark that point along the line that best describes your sleep quality in the past 7 days: Horrible Wonderful The following questions ask about your sleep in the past 7 days and nights. Please circle the one best answer for each question In the past week, how much were you by: Not at all Slightly Moderately Severely 1. Difficulty getting to sleep at bedtime One or more awakenings after getting to sleep Waking up too early in the morning Not getting enough sleep Different sleep patterns from one night to the next Sleep occurring at odd times or not at all Intense or disturbing dreams Sensations (like noises, hot or cold pain) during the night Physical tension at night Moving too much in bed Anxiety or worries about getting to sleep Anxiety or worries about lack of sleep Anxiety or worries about what might happen during sleep General nervousness and stress Poor sleeping causing you to feel stress Stress causing poor sleeping Your mind is not slowing down at bedtime Loss of desire for physical intimacy or sex Sleep that doesn't fully refresh you Difficulty waking up Poor alertness during the daytime Difficulty keeping your thoughts focused Your mind never slowing down during the daytime Difficulty remembering things Difficulty thinking clearly and making decisions

10 In the past week, how much were you by: Not at all Slightly Moderately Severely 26.Tiredness or fatigue Dozing off or napping when you really didn't want to Others noticing you appeared tired or fatigued Too many difficulties to overcome Being unsure Being unsure about dealing with day-to-day problems Irritation with sounds, sights or sensations during the day Bad mood(s) because you had poor sleep Irritation with people even when they were polite Difficulty in controlling your emotions Needing to keep quiet around other people Lack of energy because of poor sleep Poor sleep that interferes with your relationships Feeling sleepy Being unable to sleep Feeling that time itself slowed down Being able to do only enough to get by Difficulty in getting along with other people Physical clumsiness Feeling physically ill or prone to infections Being forced to pay special attention to what you eat or what you do so that you can sleep better C. Please circle the best answer for each question about the past week 47. From the time you tried to go to sleep, how long did it take to fall asleep on the worst night? 0 Less than ½ hour 1 Between ½ to 1 hour 2 Between 1 to 3 hours 3 More than 3 hours or I didn t sleep 48. From the time you tried to go to sleep, how long did it take to fall asleep on the most nights? 0 Less than ½ hour 1 Between ½ to 1 hour 2 Between 1 to 3 hours 3 More than 3 hours or I didn t sleep 49. If you woke up during the night, how long did it take to fall back to sleep on the worst night? 0 Less than ½ hour 1 Between ½ to 1 hour 2 Between 1 to 3 hours 3 More than 3 hours or I didn t sleep 10

11 50. If you woke up during the night, how long did it take to fall back to sleep on most nights? 0 Less than ½ hour 1 Between ½ to 1 hour 2 Between 1 to 3 hours 3 More than 3 hours or I didn t sleep 51. Not counting times when you were awake in bed, how many hours of actual sleep did you get during the worst night? 0 More than 7 hours 1 Between 4 to 7 hours 2 Between 2 to 4 hours 3 Less than 2 hours or I didn t sleep 52. Not counting times when you were awake in bed, how many hours of actual sleep did you get during most nights? 0 More than 7 hours 1 Between 4 to 7 hours 2 Between 2 to 4 hours 3 Less than 2 hours or I didn t sleep 53. On how many nights did it take longer than 30 minutes to fall to sleep? 0 None or 1 night 1 On 2 or 3 nights 2 On 4 or 5 nights 3 On 6 or all nights 54. On how many nights did you wake up and have trouble falling back to sleep? 0 None or 1 night 1 On 2 or 3 nights 2 On 4 or 5 nights 3 On 6 or all nights 55. On how many mornings did you wake up not fully rested? 0 None or 1 morning 1 On 2 or 3 mornings 2 On 4 or 5 mornings 3 On 6 or all mornings 56. On how many days did you have trouble coping because of poor sleep? 0 None or 1 day 1 On 2 or 3 days 2 On 4 or 5 days 3 On 6 or all days 11

12 D. Over the past week, how would you rate Excellent Good Fair Poor 57. Your sleep quality, compared to most people Your satisfaction with your sleep Your ability to get things done, compared to your best Your satisfaction with how you got things done The regularity of your sleep The soundness of your sleep How well you talked and communicated with others Your sense of humour Your quality of life E. Thank you for completing this rating scale We welcome your comments References Moul, D.E., Pilkonis, P.A., Miewald, J.M., Carey, T.J.,Buysse, D.J.(2002). Preliminary study of the test-retest reliability and concurrent validities of the Pittsburgh Insomina Rating Scale (PIRS). Sleep 25 (Abstract Supplement) A

13 RESEARCH STUDY: RELATIONSHIP BETWEEN PAIN AND SLEEP IN SPINAL CORD INJURY PATIENTS Restless Legs Syndrome Rating Scale The International Restless Legs Syndrome Study Group. Validation of the International Restless Legs Syndrome Study Group Rating Scale for restless legs syndrome. Sleep Med 2003; 4(2): Please fill in the following information: Participant s Name: Date: Restless Legs Syndrome Rating Scale The participant must rate his/her symptoms for the following ten questions. 1. Overall, how would you rate the RLS discomfort in you legs or arms? (4) Very severe (3) Severe (2) Moderate (1) Mild 2. Overall, how would you rate the need to move around because of your RLS symptoms? (4) Very severe (3) Severe (2) Moderate (1) Mild 3. Overall, how much relief of your RLS arm or leg discomfort do you get from moving around? (4) No relief (3) Slight relief (2) Moderate relief (1) Either complete or almost complete relief (0) No RLS symptoms and therefore question does not apply 4. Overall, how severe is your sleep disturbance from your RLS symptoms? (4) Very severe (3) Severe (2) Moderate (1) Mild 5. How severe is your tiredness or sleepiness from your RLS symptoms? 13

14 (4) Very severe (3) Severe (2) Moderate (1) Mild 6. Overall, how severe is your RLS as a whole? (4) Very severe (3) Severe (2) Moderate (1) Mild 7. How often do you get RLS symptoms? (4) Very severe (This means 6 to 7 days a week.) (3) Severe (This means 4 to 5 days a week.) (2) Moderate (This means 2 to 3 days a week.) (1) Mild (This means 1 day a week or less.) 8. When you have RLS symptoms, how severe are they on an average day? (4) Very severe (This means 8 hours per 24 hour day or more.) (3) Severe (This means 3 to 8 hours per 24 hour day.) (2) Moderate (This means 1 to 3 hours per 24 hour day.) (1) Mild (This means less than 1 hour per 24 hour day.) 9. How severe is the impact of your RLS symptoms on your ability to carry out overall daily affairs (4) Very severe (3) Severe (2) Moderate (1) Mild 10. How severe is your mood disturbances from your RLS symptoms for example angry, depressed, sad, anxious, or irritable? (4) Very severe (3) Severe (2) Moderate (1) Mild Very severe=31-40 points Severe=21-30 points Moderate=11-20 points Mild=1-10 points None=0 points 14

15 RESEARCH STUDY: RELATIONSHIP BETWEEN PAIN AND SLEEP IN SPINAL CORD INJURY PATIENTS The Center for epidemiological studies-depression scale (CES-D) Name of participant Date: Below is a list of some of the ways you may have felt or behaved. Please indicate how often you ve felt this way during the past week. Respond to all items. Place a check mark ( ) in the appropriate Rarely or none of the time Some or a little of the Occasionally or a moderate All of the time (5-7 days) column. During the past week (less than 1 day) time (1-2days) amount of time (3-4 days) 1. I was by things that usually don t bother me. 2. I did not feel like eating; my appetite was poor. 3. I felt that I could not shake off the blues even with help from my family. 4. I felt that I was just as good as other people. 5. I had trouble keeping my mind on what I was doing. 6. I felt depressed. 7. I felt that everything I did was an effort. 8. I felt hopeful about the future. 9. I thought my life had being a failure. 10. I felt fearful. 11. My sleep was restless. 12. I was happy. 13. I talked less than usual. 14. I felt lonely. 15. People were unfriendly. 16. I enjoyed life. 17. I had crying spells. 18. I felt sad 19. I felt that people disliked me. 20. I could not get going. Reference: Radloff, L.S. (1997). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement 1: