Örebro Musculoskeletal Pain Screening Questionnaire (Short)

Name : _________________________________________________

Date of Birth : _________________________

Are you :

  • Male
  • Female

1. How long have you had your current pain problem? Tick (√) one.

  • 0-1 weeks [ 1 ]
  • 1-2 weeks [ 2 ]
  • 3-4 weeks [ 3 ]
  • 4-5 weeks [ 4 ]
  • 6-8 weeks [ 5 ]
  • 9-11 weeks [ 6 ]
  • 3-6 months [ 7 ]
  • 6-9 months [ 8 ]
  • 9-12 months [ 9 ]
  • over 1 year [ 10 ]

2. How would you rate the pain that you have had during the past week? Circle one.

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
    • No pain
    • Pain as bad as it could be

Please circle the one number which best describes your current ability to participate in each of these activities.

3. I can do light work for an hour.

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
    • Can’t do it because
      of the pain problem
    • Can do it without pain
      being a problem
10-x

4. I can sleep at night.

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
    • Can't do it because
      of the pain problem
    • Can do it without pain
      being a problem
10-x

5. How tense or anxious have you felt in the past week? Circle one.

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
    • Absolutely calm and relaxed
    • As tense and anxious as I’ve ever felt

6. How much have you been bothered by feeling depressed in the past week? Circle one.

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
    • Not at all
    • Extremely

7. In your view, how large is the risk that your current pain may become persistent?

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
    • No risk
    • Very large risk

8. In your estimation, what are the chances you will be working your normal duties in 3 months

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
    • No chance
    • Very Large Chance
10-x

Here are some of the things which other people have told us about their pain. For each statement please circle one number from 0-10 to say how much physical activities, such as bending, lifting, walking, or driving affect your pain.

9. An increase in pain is an indication that I should stop what I’m doing until the pain decreases.

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
    • Completely disagree
    • Completely agree

10. I should not do my normal work with my present pain.

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
    • Completely disagree
    • Completely agree

SUM :