Fibromyalgia Impact Questionnaire (Fiq) Form Page 3
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4FIBROMYALGIA IMPACT QUESTIONNAIRE (FIQ)
Directions
:
For the remaining items, mark the point on the line that best indicates how you felt overall for
the past week.
14. When you worked, how much did pain or other symptoms of your Fibromyalgia interfere with your
ability to do your work, including housework?
●___І ___І___І ___І___І ___І ___І ___І ___І___●
No problem with work
Great difficulty with work
15. How bad has your pain been?
●___І ___І___І ___І___І ___І ___І ___І ___І___●
No pain
Very severe pain
16. How tired have you been?
●___І ___І___І ___І___І ___І ___І ___І ___І___●
No tiredness
Very tired
17. How have you felt when you get up in the morning?
●___І ___І___І ___І___І ___І ___І ___І ___І___●
Awoke well rested
Awoke very tired
18. How bad has your stiffness been?
●___І ___І___І ___І___І ___І ___І ___І ___І___●
No stiffness
Very stiff
19. How nervous or anxious have you felt?
●___І ___І___І ___І___І ___І ___І ___І ___І___●
Not anxious
Very anxious
20. How depressed or blue have you felt?
●___І ___І___І ___І___І ___І ___І ___І ___І___●
Not depressed
Very depressed
21. If you were to spend the rest of your life with Fibromyalgia and your current symptoms,
how would you feel about that?
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Parent category: Life