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. Author manuscript; available in PMC: 2011 Sep 2.
Published in final edited form as: Pain. 2008 Aug 8;139(3):644–652. doi: 10.1016/j.pain.2008.06.022

Not very
difficult
A little
difficult
Somewhat
difficult
Very
difficult
Extremely
difficult

1. Going to school 0 1 2 3 4
2. Gym 0 1 2 3 4
3. Reading 0 1 2 3 4
4. Schoolwork 0 1 2 3 4
5. Sports 0 1 2 3 4
6. Doing a hobby 0 1 2 3 4
7. Playing with friends 0 1 2 3 4
8. Watching TV 0 1 2 3 4
9. Housework or chores 0 1 2 3 4
10. Working at a job 0 1 2 3 4
11. After school practices 0 1 2 3 4
12. Doing things with friends 0 1 2 3 4
13. Going to clubs/church activities 0 1 2 3 4
14. Running 0 1 2 3 4
15. Walking up stairs 0 1 2 3 4
16. Eating regular meals 0 1 2 3 4
17. Riding in the school bus or car 0 1 2 3 4
18. Walking one or two blocks 0 1 2 3 4
19. Sleep 0 1 2 3 4
20. Riding a bike or scooter 0 1 2 3 4
21. Being up all day (without a nap or rest) 0 1 2 3 4