Possible Psychological Responses to Pain (check any
that apply to you)
Overeating or loss of appetite.
Loss of sexual desire and/or performance.
Distressing or frightening dreams.
Easily startled.
Concentration difficulties or poor memory.
Angry outbursts or frequently frustrated.
Tired, fatigued, or irritable.
Restless or anxious for no apparent reason.
Increase in alcohol use.
Increase in smoking.
Stress regarding financial or legal issues.
Agitation or depression related to chronic pain.
Increase in marital and/or familial conflict.
Fear of driving.
Fear of further injury during daily routines.
Frequent concern about the future.
Feelings of helplessness or hopelessness.
Feelings of embarrassment, guilt, or shame.
Thoughts of being an inconvenience to others.
Frequent headaches and/or muscle tension in neck area.
Difficulty staying asleep or early morning awakening.
Flashbacks of accident or trauma.
Isolating or spending less time with friends.
Using pain medication more than prescribed.
Passing thoughts of suicide with or without intent.
Panic or anxiety attacks.
Feeling apathetic or low energy.
Periods of weeping or overly sensitive.
Difficulty falling asleep or sleeping too much.
Verbally and/or physically abusive to others.
Please check the statements that apply to you. Checking any of the above statements may suggest a psychological impact has occurred due to your medical condition(s) and/or chronic pain. Please discuss with your treating physician the benefit of a behavioral healthcare evaluation.