Pain self-efficacy questionnaireRuth Smith2020-06-24T08:41:53+00:00

PSEQ

Name*
First Last
Date*
Date Format: MM slash DD slash YYYY
Please rate how confident you are that you can do the following things at present, despite the pain. To indicate your answer circle one of the numbers on the scale under each item, where 0 = not at all confident and 6 = completely confident.

Remember, this questionnaire is not asking whether of not you have been doing these things, but rather how confident you are that you can do them at present, despite the pain
1. I can enjoy things, despite the pain.*
0 - Not at all confident 1 2 3 4 5 6- Completely confident
2. I can do most of the household chores (e.g. tidying-up, washing dishes, etc.), despite the pain.*
0 - Not at all confident 1 2 3 4 5 6- Completely confident
3. I can socialise with my friends or family members as often as I used to do, despite the pain.*
0 - Not at all confident 1 2 3 4 5 6- Completely confident
4. I can cope with my pain in most situations.*
0 - Not at all confident 1 2 3 4 5 6- Completely confident
5. I can do some form of work, despite the pain. (“work” includes housework, paid and unpaid work).*
0 - Not at all confident 1 2 3 4 5 6- Completely confident
6. I can still do many of the things I enjoy doing, such as hobbies or leisure activity, despite pain.*
0 - Not at all confident 1 2 3 4 5 6- Completely confident
7. I can cope with my pain without medication.*
0 - Not at all confident 1 2 3 4 5 6- Completely confident
8. I can still accomplish most of my goals in life, despite the pain.*
0 - Not at all confident 1 2 3 4 5 6- Completely confident
9. I can live a normal lifestyle, despite the pain.*
0 - Not at all confident 1 2 3 4 5 6- Completely confident
10. I can gradually become more active, despite the pain.*
0 - Not at all confident 1 2 3 4 5 6- Completely confident

PSEQ

QUICK LINKS

FORMS