Table 3.

Patient assessment of constipation symptom questionnaire (PAC-SYM)

Domain	Item
Abdominal	• Discomfort in your stomach
	• Pain in your stomach
	• Bloating in your stomach
	• Stomach cramps
Rectal	• Painful bowel movements
	• Rectal burning during or after bowel movement
	• Rectal bleeding or tearing during or after bowel movement
Stool	• Incomplete bowel movements, like you did not “finish”
	• Bowel movements that were too hard
	• Bowel movements that were too small
	• Straining or squeezing to try to pass a bowel movement
	• Feeling like you had to pass a bowel movement but could not (“false alarm”)

Notes: PAC-SYM comprises three domains: abdominal, rectal, and stool symptom mechanisms. Responses are scored as 0, absence of symptoms; 1, mild symptoms; 2, moderate symptoms; 3, severe symptoms; and 4, very severe symptoms. Adapted with permission from: Slappendel R, Simpson K, Dubois D, Keininger DL; European Journal of Pain; John Wiley and Sons; Validation of the PAC-SYM questionnaire for opioid-induced constipation in patients with chronic low back pain; 2006;10(3):209–217; Copyright © 1999–2015 John Wiley & Sons, Inc. All Rights Reserved.40