Psychosocial Pain Assessment Form Page 7
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8Coping
People handle pain and distress in many ways. These questions will help us to better understand how
you cope with upsetting situations.
1. Sometimes, doing things we enjoy distracts us from our pain. What activities are you able to do that
you enjoy?
None _____
Family _____
Friends _____
Hobbies _____
Reading _____
Religion _____
Gardening _____
Traveling _____
Exercise _____
Art/Music _____
TV _____
Pets _____
Other: _______
2. Some people find comfort in spirituality to help them cope with difficult situations. What role does
spirituality have in helping you?
Describe:
________________________________________________________________________________
________________________________________________________________________________
3. Many people in your situation ask "Why did this happen to me?" How have you attempted to "make
sense" of your painful experiences?
Describe:
_________________________________________________________________________________
_________________________________________________________________________________
4. Past stressful events can impact us in the present. What kinds of stress have you had to handle
before? Describe:
________________________________________________________________________________
________________________________________________________________________________
Child abuse? Yes___ No___ Describe: _________________________________________________
Sexual abuse? Yes___ No___ Describe: ________________________________________________
Family violence? Yes___ No___ Describe: _____________________________________________
5. Some people find that counseling sessions or attending support groups can help them cope with
stressful situations.
Have you ever been in counseling? Yes ___No___ What was the focus of your therapy?__________
Have you ever attended a support group? Yes ___No___ What kind? _________________________
How helpful was this?
________________________________________________________________________________
6. Some people are prescribed medications to help them cope. Which of these have you been
prescribed?
None _____
Other: ___________________________________________________________________________
Anti-Anxiety medications? Yes___ No ___ Describe: _____________________________________
Anti-Depressant medications? Yes___ No ___ Describe: __________________________________
Pain Medications? Yes___ No___ Describe: ____________________________________________
Do you ever take your prescriptions differently than ordered? Yes ___No___
Describe: _______________________________________________________________________
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