Questionnaire for Neuropathic Pain

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Question 1: Does your pain have one or more of the following characteristics?
BurningCold is painfulElectric Shocks

Question 2: Is the pain associated with one or more of the following symptoms in the same area?
TinglingPins and needlesNumbnessItching

Question 3: Is the pain located in an area where you feel one or both of the following characteristics?
decreased sensitivity to touchdecreased sensitivity to pinprick

Question 4: Do you feel that the pain is caused or increased by:
light touch

Thank You for completing this questionnaire to let us better understand your pain.

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