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This questionnaire has been designed to provide you and your treating physician with information as to how your back pain has affected your ability to manage your everyday life.

Please answer every section and mark in each section the statement that most accurately applies to you. We realize you may consider that two of the statements in any one section relate to you, but please mark the box which MOST CLOSELY describes you.

LOWER BACK PAIN INTRODUCTION

Lower back pain is the most common pain condition in adults over their lifetime. Studies report that over 80% of adults will experience low back pain within their lifetime. It is also the most common cause of job-related disability and missed days at work for millions of Americans.

LOWER BACK PAIN INTRODUCTION

Lower back pain is the most common pain condition in adults over their lifetime. Studies report that over 80% of adults will experience low back pain within their lifetime. It is also the most common cause of job-related disability and missed days at work for millions of Americans.