| The following questions are about pain you may have experienced in the past 3 months. Please refer to pain that lasted a whole day or more. |
| Question |
Response |
Item Code |
| During the past 3 months, did you have neck pain? |
Yes |
NECK3 |
| During the past 3 months, did you have low back pain? |
Yes |
LBP3 |
| Did this pain spread down either leg to areas below the knees? |
Yes |
LBP3R |
| During the past 3 months, did you have severe headaches or migraines? |
Yes |
HAM3 |
| Have you had a problem with pain that lasted more 1 month, more than 3 months, or more than 1 year? Subjects who answer affirmative proceed to the following. |
| Regarding your pain problem, which regions are affected? |
Item Code |
| Head affected |
CPHEAD |
| Face/dental affected |
| Right shoulder girdle affected |
CPSHDR |
| Left shoulder girdle affected |
| Right upper arm affected |
CPARM |
| Left upper arm affected |
| Right mid-arm affected |
| Left mid-arm affected |
| Right lower arm affected |
| Left lower arm affected |
| Right upper back affected |
CPUBACK |
| Left upper back affected |
| Right lower back affected |
CPLBACK |
| Left lower back affected |
| Right buttock affected |
| Left buttock affected |
| Spine affected |
| Right upper leg affected |
CPLEG |
| Left upper leg affected |
| Right mid-leg affected |
| Left mid-leg affected |
| Right lower leg affected |
| Left lower leg affected |
| Neck affected |
CPNECK |
| Sternum affected |
CPCHEST |
| Right chest affected |
| Left chest affected |
| Abdomen affected |
CPABD |
| Right hand affected |
CPHAND |
| Left hand affected |
| Right foot affected |
CPFOOT |
