¬

Chronic Pain Acceptance Questionnaire

Below you will find a list of statements. Please rate the truth of each statement as it
applies to you. Use the following rating scale to make your choices. For instance, if you
believe a statement is ‘Always True,’ you would write a 6 in the blank next to that
statement.

0=Never        1= Very rarely true           2=Seldom true            3=Sometimes true
4=Often true           5=Almost always true     6=Always true

_____ 1. I am getting on with the business of living no matter what my level of pain is.
_____ 2. My life is going well, even though I have chronic pain.
_____ 3. It’s OK to experience pain.
_____ 4. I would gladly sacrifice important things in my life to control this pain better.
_____ 5. It’s not necessary for me to control my pain in order to handle my life well.
_____ 6. Although things have changed, I am living a normal life despite my chronic
	pain.
_____ 7. I need to concentrate on getting ride of my pain.
_____ 8. There are many activities I do when I feel pain.
_____ 9. I lead a full life even though I have chronic pain.
_____ 10. Controlling my pain is less important than any other goals in my life.
_____ 11. My thoughts and feelings about pain must change before I can take important
	steps in my life.
_____ 12. Despite the pain, I am now sticking to a certain course in my life.
_____ 13. Keeping my pain level under control takes first priority whenever I’m doing
	something.
_____ 14. Before I can make any serious plans, I have to get some control over my pain.
_____ 15. When my pain increases, I can still take care of my responsibilities.
_____ 16. I will have better control over my life if I can control my negative thoughts
	about pain.
_____ 17. I avoid putting myself in situations where my pain might increase.
_____ 18. My worries and fears about what pain will do to me are true.
_____ 19. It’s a great relief to realize that I don’t have to change my pain to get on with
	life.
_____ 20. I have to struggle to do things when I have pain.

Authors: Lance M. McCracken, Kevin E. Vowles, & Christopher Eccleston.