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Brief Pain Inventory

0 No Pain 10 Pain as bad as you can imagine

0 No Pain 10 Pain as bad as you can imagine

0 No Pain 10 Pain as bad as you can imagine

0 No Pain 10 Pain as bad as you can imagine

0% No Relief 100% Complete Relief

9) Circle the one number that describes how, during the past 24 hours, PAIN HAS INTERFERED with your:

0 Does not Interfere 10 Completely interfere