CDE Detailed Report

Disease: Multiple Sclerosis
Sub-Domain: Activities of Daily Living/Performance
CRF: Brief Pain Inventory (Short Form)

Displaying 1 - 15 of 15
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C09582 Brief Pain Inventory (BPI) - relief received percentage number BPIRelfRecvdPctNum Indicates the relief received from medication use, as part of the Brief Pain Inventory (BPI) form. Indicates the relief received from medication use, as part of the Brief Pain Inventory (BPI) form. In the last 24 hours, how much relief have pain treatments or medications provided? 0;0.1;0.2;0.3;0.4;0.5;0.6;0.7;0.8;0.9;1 No relief;;;;;;;;;;Complete relief Numeric Values

Please circle the one percentage that most shows how much relief you have received Use the scale of 0% = no relief and 100% = complete relief

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09583 Brief Pain Inventory (BPI) - pain general activity interference scale BPIPainGenrlActIntfrrnScale Scale assessing how much the pain has interfered with general activity, as part of the Brief Pain Inventory (BPI) form. Scale assessing how much the pain has interfered with general activity, as part of the Brief Pain Inventory (BPI) form. General Activity 0;1;2;3;4;5;6;7;8;9;10 Does not interfere;;;;;;;;;;Completely interferes Numeric Values

Circle the one number that describes how, during the past 24 hours, pain has interfered with your: Use the scale of 0 = does not interfere and 10 = completely interferes

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09584 Brief Pain Inventory (BPI) - pain mood interference scale BPIPainMdIntfrrncScale Scale assessing how much the pain has interfered with mood, as part of the Brief Pain Inventory (BPI) form. Scale assessing how much the pain has interfered with mood, as part of the Brief Pain Inventory (BPI) form. Mood 0;1;2;3;4;5;6;7;8;9;10 Does not interfere;;;;;;;;;;Completely interferes Numeric Values

Circle the one number that describes how, during the past 24 hours, pain has interfered with your: Use the scale of 0 = does not interfere and 10 = completely interferes

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09585 Brief Pain Inventory (BPI) - pain walking ability interference scale BPIPainWlkngAblIntfrrncScale Scale assessing how much the pain has interfered with walking ability, as part of the Brief Pain Inventory (BPI) form. Scale assessing how much the pain has interfered with walking ability, as part of the Brief Pain Inventory (BPI) form. Walking Ability 0;1;2;3;4;5;6;7;8;9;10 Does not interfere;;;;;;;;;;Completely interferes Numeric Values

Circle the one number that describes how, during the past 24 hours, pain has interfered with your: Use the scale of 0 = does not interfere and 10 = completely interferes

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09575 Brief Pain Inventory (BPI) - other pain indicator BPIOthrPainInd Indicates if the subject had pain other than everyday kinds of pain, as part of the Brief Pain Inventory (BPI) form. Indicates if the subject had pain other than everyday kinds of pain, as part of the Brief Pain Inventory (BPI) form. Throughout our lives, most of us have had pain from time to time (such as minor Headaches, sprains, and toothaches). Have you had pain other than these everyday kinds of pain today? 1;2 Yes;No Numeric values

No instructions available

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09586 Brief Pain Inventory (BPI) - pain normal work interference scale BPIPainNormWrkIntfrrncScale Scale assessing how much the pain has interfered with normal work, as part of the Brief Pain Inventory (BPI) form. Scale assessing how much the pain has interfered with normal work, as part of the Brief Pain Inventory (BPI) form. Normal Work (includes both work outside the home and housework) 0;1;2;3;4;5;6;7;8;9;10 Does not interfere;;;;;;;;;;Completely interferes Numeric Values

Circle the one number that describes how, during the past 24 hours, pain has interfered with your: Use the scale of 0 = does not interfere and 10 = completely interferes

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09576 Brief Pain Inventory (BPI) - pain area indicator BPIPainAreaInd On the diagram, shade in the areas where you feel pain. Put an X on the area that hurts the most, as part of the Brief Pain Inventory (BPI) form. On the diagram, shade in the areas where you feel pain. Put an X on the area that hurts the most, as part of the Brief Pain Inventory (BPI) form. On the diagram, shade in the areas where you feel pain. Put an X on the area that hurts the most. Alphanumeric

Refer to CRF for diagram of human body

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points 255

Free-Form Entry

C09587 Brief Pain Inventory (BPI) - pain relations interference scale BPIPainRelateIntfrrnScale Scale assessing how much the pain has interfered with relations with other people, as part of the Brief Pain Inventory (BPI) form. Scale assessing how much the pain has interfered with relations with other people, as part of the Brief Pain Inventory (BPI) form. Relations with other people 0;1;2;3;4;5;6;7;8;9;10 Does not interfere;;;;;;;;;;Completely interferes Numeric Values

Circle the one number that describes how, during the past 24 hours, pain has interfered with your: Use the scale of 0 = does not interfere and 10 = completely interferes

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09577 Brief Pain Inventory (BPI) - worst pain rating scale BPIWrstPainRtngScale Scale indicating the rating of the worst pain, as part of the Brief Pain Inventory (BPI) form. Scale indicating the rating of the worst pain, as part of the Brief Pain Inventory (BPI) form. Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours 0;1;2;3;4;5;6;7;8;9;10 No Pain;;;;;;;;;;pain as bad as you can imagine Numeric Values

Use the scale of 0 = no pain and 10 = pain as bad as you can imagine

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09588 Brief Pain Inventory (BPI) - pain sleep interference scale BPIPainSlpIntfrrnScale Scale assessing how much the pain has interfered with sleep, as part of the Brief Pain Inventory (BPI) form. Scale assessing how much the pain has interfered with sleep, as part of the Brief Pain Inventory (BPI) form. Sleep 0;1;2;3;4;5;6;7;8;9;10 Does not interfere;;;;;;;;;;Completely interferes Numeric Values

Circle the one number that describes how, during the past 24 hours, pain has interfered with your: Use the scale of 0 = does not interfere and 10 = completely interferes

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09578 Brief Pain Inventory (BPI) - least pain rating scale BPILstPainRtngScale Scale indicating the rating of the least pain experienced by the subject, as part of the Brief Pain Inventory (BPI) form. Scale indicating the rating of the least pain experienced by the subject, as part of the Brief Pain Inventory (BPI) form. Please rate your pain by circling the one nuimber that best describes your pain at its least in the last 24 hours 0;1;2;3;4;5;6;7;8;9;10 No Pain;;;;;;;;;;pain as bad as you can imagine Numeric Values

Use the scale of 0 = no pain and 10 = pain as bad as you can imagine

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09589 Brief Pain Inventory (BPI) - pain enjoyment interference scale BPIPainEnjmntIntfrrncScale Scale assessing how much the pain has interfered with enjoyment of life, as part of the Brief Pain Inventory (BPI) form. Scale assessing how much the pain has interfered with enjoyment of life, as part of the Brief Pain Inventory (BPI) form. Enjoyment of life 0;1;2;3;4;5;6;7;8;9;10 Does not interfere;;;;;;;;;;Completely interferes Numeric Values

Circle the one number that describes how, during the past 24 hours, pain has interfered with your: Use the scale of 0 = does not interfere and 10 = completely interferes

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09579 Brief Pain Inventory (BPI) - average pain rating scale BPIAvgPainRtngScale Scale indicating the rating of the average pain experienced by the subject, as part of the Brief Pain Inventory (BPI) form. Scale indicating the rating of the average pain experienced by the subject, as part of the Brief Pain Inventory (BPI) form. Please rate your pain by circling the one number that best describes your pain on the average 0;1;2;3;4;5;6;7;8;9;10 No Pain;;;;;;;;;;pain as bad as you can imagine Numeric Values

Use the scale of 0 = no pain and 10 = pain as bad as you can imagine

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09580 Brief Pain Inventory (BPI) - current pain rating scale BPICurntPainRtngScale Scale rating the pain the subject is feeling right now, as part of the Brief Pain Inventory (BPI) form. Scale rating the pain the subject is feeling right now, as part of the Brief Pain Inventory (BPI) form. Please rate your pain by circling the one number that tells how much pain you have right now 0;1;2;3;4;5;6;7;8;9;10 No Pain;;;;;;;;;;pain as bad as you can imagine Numeric Values

Use the scale of 0 = no pain and 10 = pain as bad as you can imagine

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C09581 Brief Pain Inventory (BPI) - treatment received text BPITreatmtRecvdTxt Text of treatment/medication subject receives for the pain, as part of the Brief Pain Inventory (BPI) form. Text of treatment/medication subject receives for the pain. What treatments or medications are you receiving for your pain Alphanumeric

No instructions available

Daut R. et al. Development of the Wisconsin Brief Pain Questionnire to assess pain in cancer and other diseases. Pain, 1983; 17: 197-210. Keller et al. Validity of the brie pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20: 309-318. Tan G. et al. Validation of the brief pain inventory for nonmalignant pain. J Pain 2004; 5: 133-137. Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Brief Pain Inventory (Short Form) Activities of Daily Living/Performance Outcomes and End Points 255

Free-Form Entry

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