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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.



Home Address:______________________________________________City/State/Zip_____________________________________

Employer: __________________________________________________________________________________________________

Office Address______________________________________________City/State/Zip_____________________________________

Home Phone:__________________________________ Office Phone:__________________________________


Work History:________________________________________________________________________________________________

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

Pain Hist. Tingling Numbness Fatigue Swelling Loss of
L, M, S
Length of
Time (Years)



Leisure Activities Affected? _______Yes ________No.

If "Yes", which ones?________________________________________________________________________________________

Medical Treatment?__________________________________________________________________________________________

Loss of Time?______________________________________________________________________________________________


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.

The questionnaire is designed as a grid with eight anatomic sites vertically arranged in the left column and eight symptoms horizontally arranged on the top line. This makes a total of sixty-four squares.

It is very important to complete the last two lines, i.e. "Severity - light, moderate, or severe," and "Length of time in years," as these are critical in quantifying the information in the sixty-four square grid.

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


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