Ticked Bucket List Neuropathic Pain Screening Questionnaire

1. How do you rate your pain at this moment?

2. How do you rate the severest pain during the past 4 weeks?

3. How do you rate the average pain in the past 4 weeks?

4. Pain pattern during the past 4 weeks?

5. Does your pain radiate to other regions of the body?

6. Do you have a tingling or prickling sensation in the area of your pain?

7. Do you feel burning sensations?

8. Does cold, cold breeze, or heat trigger pain?

9. Do you feel numbness in the sites of pain?

10. Do you feel increased pain when lightly touching the affected area?

This free Neuropathic Pain Screening Questionnaire is based on validated screening tools and designed to help you better understand your condition.

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