Variables / outcomes

VariablesMeasurement toolInitial QuestionnaireFollow up Questionnaire
Patient ID (site, language, ID)

 

XX
Date of completion of the questionnaire

 

XX
Pain location

All painful areas

 

Body map

 

X

 

X

Most painful areaBody mapXX
Pain area(s) for which the patient has been referred to the clinic

 

Body mapXX
Circumstances surrounding the onset of the pain for which the patient has been referred to the clinic

 

 

X

Duration of the pain for which the patient has been referred to the clinic

 

X
Frequency of the pain for which the patient has been referred to the clinic (continuous or intermittent)

 

XX
Neuropathic component of the pain for which the patient has been referred to the clinic

 

Self-reported portion of the DN4XX
Presence of pain in the past 7 days

 

XX
Worst pain intensity in the past 7 days

 

PROMIS 0-10 pain intensity scale (0 = no pain, 10 = worst imaginable pain)XX
Average pain intensity in the past 7 days

 

PROMIS 0-10 scaleXX
Pain interferenceInterference items of the Brief Pain InventoryXX
Physical functioningPhysical functioning subscale of the SF-12XX
AnxietyAnxiety Subscale of the Patient Health Questionnaire – 4XX
DepressionDepression Subscale of the Patient Health Questionnaire – 4X

 

X
Psychological distressPatient Health Questionnaire – 4XX
Age

 

X
Biological sex at birth (female, male, intersex, prefer not to disclose the information)

 

X
Gender (woman, man, do not identify within the gender binary, prefer not to disclose the information)

 

X
Preferred gender pronoun (she/her, he/his, they/them, prefer to use another gender pronoun (specify)

 

X
Employment status

 

XX
Canadian Armed Forces
EverX
Currently activeXX
Year of releaseXX
Pain related to the work in the Canadian Armed Forces

 

XX