Canadian Pain Management

P-3 Questionnaire

INSTRUCTIONS: The purpose of the P-3 is to assess your emotional functioning. The information obtained from this assessment with help your health care provider design a treatment program for you. If you have any questions about the P-3, please ask your health care provider.

The P-3 consists of 44 groups of statements. Each group has three choices- 1, 2, and 3. Read each group of statements carefully. Choose the ONE statement in each group that best describes how you have been feeling LATELY, including TODAY. Be sure to read all of the statements in each group before making your choice. Then circle the number next to the statement you choose. Do not leave any groups blank. If none of the groups describes exactly how you feel, choose the statement that comes closest to describing how you feel.

Name of Client:

(1)	I usually sleep well. I have some trouble with sleep. I have a lot of trouble with sleep.
(2)	I am a calm person." name="input3">I am a calm person. I am probably more nervous than most people. I often feel so nervous and on edge that I am miserable.
(3)	Sometimes I think bad or evil thoughts about people. I always think only the very best about most people. I always think only the very best about all people.
(4)	I can do my work and chores around the house. With help I can do my work and chores around the house. I can no longer do my work and chores around the house.
(5)	I have no more pain problems than most people. I seem to have more pain problems than others. My life is spent in pain.
(6)	I wake feeling pretty good most mornings. I wake feeling tired many mornings. I wake with pain and feeling tired most mornings
(7)	I will sometimes tell people what I think they want to hear rather than the truth. I will occasionally tell a lie. I never tell a lie.
(8)	People can count on me because I get things done. I sometimes have trouble completing tasks. Much of the time I feel useless to myself and others.
(9)	My memory is fine. My memory is not as good as it used to be. I have serious trouble remembering things.
(10)	My general health is as good as most people’s. Most people seem to be in better general health than I am. I have some serious health problems.
(11)	I am a happy person. I don’t seem to be as happy as most people. I am not happy.
(12)	I get things done and on time. I sometimes struggle to keep my concentration. I seem to have trouble completing tasks because I keep getting sidetracked.
(13)	Most of the time I feel pretty good. I seem to tire easier than most people. I feel weak and tired much of the time.
(14)	There are several people in my life who treat me unfairly. Some people seem to treat me unfairly. Many people seem to treat me unfairly.
(15)	I am interested in outside activities and other people. I have little interest in outside activities and other people. I have no interest in outside activities and other people.
(16)	I am usually at peace with myself and others. I seem to get angry more than I used to. I feel angry with somebody or something much of the time.
(17)	I seldom have a headache. I have more headaches than most people. I seem to have a headache much of the time.
(18)	I trust some people but not others. I trust only a very few people. I believe that most people are only out for themselves and don’t care about others.
(19)	I am comfortable enough in a group of people. In a group of people I sometimes feel nervous. In a group of people I often feel like I don’t belong.
(20)	It takes a lot to get me upset. I get upset easier than I used to. It seems like I stay upset much of the time.
(21)	It takes a lot before I get tired. I tire easily. I stay tired most of the time.
(22)	I have no trouble making decisions. Sometimes I struggle making decisions. I now have more trouble making decisions than I used to.
(23)	My mind is usually relaxed. Even when I am still, my mind seems to be racing. It is sometimes impossible to get my mind to relax.
(24)	My neck and shoulders feel normal. My neck and shoulders feel tight. My neck and shoulders hurt.
(25)	No matter what the problem, I believe there is always hope. Hoping for things to get better is beginning to be a struggle for me. Most of the time I feels hopeless that my condition will improve.
(26)	I seldom say something in anger that I later wish I hadn’t. Sometimes I say something in anger that I later wish I hadn’t. I frequently say things in anger that I later wish I hadn’t.
(27)	My stomach gives very little trouble. I seem to have more stomach trouble than most people. My stomach causes me lots of problems.
(28)	I enjoy being around other people. I can mix with others but would rather be alone. I avoid having to be around others.
(29)	The muscles in my body usually feel loose and relaxed. The muscles in my body often feel tight. The muscles in my body feel painfully tight.
(30)	I seldom have neck or back pain. I will sometimes have neck or back pain. My neck or back seems to hurt most of the time.
(31)	I am physically able to do some things but not others. I am not physically able to do most things. I am not physically able to do anything.
(32)	I look forward to the future. Things much improve before I will really look forward to the future. My future seems hopeless.
(33)	I seldom feel nervous. I frequently feel nervous. I feel nervous most of the time.
(34)	I believe that most back problems go away and don’t return. I believe that most back problems may go away but are likely to return. I believe that once you have a bad back you will probably always have trouble with it.
(35)	I seldom worry about anything. I probably worry too much. I worry over almost everything.
(36)	I feel pretty calm and relaxed. I am probably more tense and uptight than I should be. Sometimes I feel like I am about to lose my mind.
(37)	Most of the time my head feels clear. Most of the time my head feels cloudy and dull. I sometimes start sweating and trembling for no known reason.
(38)	I have had my fair share of problems. I have had more than my share of problems. Recently, it seems like my life is filled with problems.
(39)	My blood pressure and heart are in good shape. I have had some problems with my blood pressure. My heart often seems to beat too hard and fast.
(40)	I am almost always happy. I am sometimes happy and sometimes sad. I am almost always sad.
(41)	My arms and legs feel fine. I sometimes have pain in my hand or foot. Sometimes my entire arm or leg feels numb.
(42)	I live a good life. Except for too many problems, my life is pretty good. My life is in a rut.
(43)	I am basically satisfied with my life at present. I have some big regrets in my life. I am not satisfied with my life at present.
(44)	I am a useful person. I am not as useful to others as I used to be. I sometimes think that everybody would be better off if I were dead.

Homepage About CPM Pain Symptoms Common Referrals Our Team Contact Us
© 2009 Canadian Pain Management Incorporated.	Website by: The Mann Group