painDETECT painDETECT clinically supported pain self-check module Step 1 of 4 25% How would you assess your pain right now?*012345678910How strong was the strongest pain during the past 4 weeks?*012345678910How strong was the pain on average during the past 4 weeks?*012345678910 Pick the statement that best describes the course of your pain:*Persistent pain with slight fluctuationsPersistent pain with pain attacksPain attacks without pain between themPain attacks with pain between themDoes your pain radiate to other regions of your body?*YesNo Do you suffer from a burning sensation (e.g. stinging nettles) in the area of your pain?*NeverHardly NoticedSlightlyModeratelyStronglyVery StronglyDo you have a tingling or prickling sensation in the area of your pain (like crawling ants or electrical tingling)?*NeverHardly NoticedSlightlyModeratelyStronglyVery StronglyIs light touching (clothing, a blanket) in this area painful?*NeverHardly NoticedSlightlyModeratelyStronglyVery Strongly Is cold or heat (bath water) in this area occasionally painful?*NeverHardly NoticedSlightlyModeratelyStronglyVery StronglyDo you suffer from a sensation of numbness in the areas that you marked?*NeverHardly NoticedSlightlyModeratelyStronglyVery StronglyDoes slight pressure in this area, e.g. with a finger, trigger pain?*NeverHardly NoticedSlightlyModeratelyStronglyVery Strongly This iframe contains the logic required to handle AJAX powered Gravity Forms.
