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The "Pain" Questionnaire: Ergonomics in Pain Management for Dental Professionals - Including Carpal Tunnel Syndrome

Before completing the Pain Questionnaire, please read the instructions on the next page.

Date:________________________________

Name:_____________________________________________________________________________________________________

Home Address:______________________________________________City/State/Zip_____________________________________

Employer: __________________________________________________________________________________________________

Office Address______________________________________________City/State/Zip_____________________________________

Home Phone:__________________________________ Office Phone:__________________________________

Graduation/School:____________________________________________________Date:___________________________________

Work History:________________________________________________________________________________________________

Yrs. Full Time:____________Yrs. Part Time_____________ Yrs. Off:____________ Total Yrs. on the Job:____________

Pain Hist. Tingling Numbness Fatigue Swelling Loss of
Strength
Work
Pain
Night
Pain
CTS
Symptoms
Severity:
L, M, S
Length of
Time (Years)

Fingers

                   
Thumb
                   
Hand
                   
Wrist
                   
Arm
                   
Shoulder
                   
Neck
                   
Back
                   


Leisure Activities Affected? _______Yes ________No.

If "Yes", which ones?________________________________________________________________________________________

Medical Treatment?__________________________________________________________________________________________

Loss of Time?______________________________________________________________________________________________

Comments?________________________________________________________________________________________________

Suggestions for Completing This Questionnaire:

Based on observations over the last few years, the cultural heritage of the hygienist has traditionally been a litany of pain. This has been extensively documented in the literature since the landmark paper by McDonald, et. al. in 1988. Consequently, many hygienists accept and tolerate fatigue and pain as long as they can stand it. Many have worked in pain for five to seven and even twelve years.

Once a person accepts dysfunctional symptoms as a normal state, then major problems can and do develop. Much damage has been done by people working as long as they can tolerate the pain. Fatigue and pain are not normal to the healthy body. The old saying "Listen to your body" is good advice. As we listen to our body, the language of "Body talk" is interesting. If there were a dictionary for the language of body talk it would contain only two words, i.e. fatigue and pain.

It was concern over these matters that resulted in the development of the "Pain Questionnaire" several years ago. It was reasoned that if more could be known about the pain history, then the hands-on session could be of greater help to those in need. That has turned out to be true.

If you wonder about your status, regarding pain, complete the following questionnaire. It is a hard fact to face, but if a person is experiencing undue fatigue, much less any occupational pain, they need to think about what can happen if the condition continues to develop. And that is how bad situations develop - they were ignored, or accepted as normal when they were just beginning.

It is called the "Pain" Questionnaire, not because it is a pain to fill out, but because this information about you can only come from you. It is the first step in helping anyone in pain, or anyone that would like to prevent pain. BECAUSE it helps you to better understand your symptoms by describing them. SO, PLEASE OBSERVE THE FOLLOWING STEPS:

On top of the grid are headings for the eleven columns. Please STUDY THE LAST THREE of these headings.

"CTS Symptoms" stands for symptoms of carpal tunnel syndrome, which may or may not have been diagnosed by a doctor. If you have experienced what you believe to be CTS, please indicate accordingly.

"Severity L.M.S." - stands for Light, Moderate , Severe. THIS IS VERY IMPORTANT.

"Length of Time in Years" THIS, ALSO, IS VERY IMPORTANT.

If you have had surgery for Carpal Tunnel Syndrome, please use one questionnaire for symptoms before surgery and another questionnaire for after surgery.

This questionnaire was developed for use in the hands-on course, and has been an invaluable help to many. It can be used by any hygienist to good advantage, especially if any symptoms are being experienced. Also, it can be used by any office or school to survey groups of hygienists or students.

I try to keep all questionnaires on file, and like to follow up on the progress of hygienists with special problems. I would appreciate your help in developing this data base.

Sincerely,

Dr. H. L. Meador

 

After completing the questionnaire, you may want to contact Dr. Meador about the interpretation. See also the "Pain Questionnaire Analysis".

 

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