Neck Pain Symptoms And How It May Affect The Ability To Manage In Activities Of Everyday Life

This modification of a questionnaire can provide some information on how neck pain symptoms affect the ability to manage activities in everyday life. There are many factors which contribute to long term or chronic neck pain problems which persist for more than 8 – 12 weeks. Depression is not uncommon in long term pain showing the need for an approach from many directions with chronic neck pain symptoms.

Neck Pain Symptoms Online Questionnaire

Answer all questions. All questions relate to your neck pain symptoms which can consist of neck pain and numbness or tingling in the arms or hands.

1 – Neck Symptoms Level

No Level Of Neck Pain Currently
Mild level of neck pain currently
Moderate Level Of Neck Pain Currently
Severe Level Of Neck Pain Currently
Unbearable Level Of Neck Pain Currently

2 – Neck Pain Symptoms and Sleeping

Sleep Not Affected By Symptoms
Sleep Occasionally Affected By Symptoms
Sleep Regularly Affected By Symptoms
Less Than 5 Hours Sleep From Night Arm Numbmess/Tingling
Less Than 2 Hours Sleep From Night Arm Numbmess/Tingling

3 – Night Arm Tingling/Numbness

No Night Arm Numbmess/Tingling
Occasional Night Arm Numbmess/Tingling
Sleep Regularly Affected By Night Arm Numbmess/Tingling
Less Than 5 Hours Sleep From Night Arm Numbmess/Tingling
Less Than 5 Hours Sleep From Night Arm Numbmess/Tingling

4 – Daytime Symptoms

No Symptoms
Symptoms For Less Than 1 Hour
Symptoms On/Off For 1 – 4 Hours
Symptoms On/Off For More Than 4 Hours
Symptoms All Day

5 – Carrying Objects

Heavy Objects With No Symptoms
Heavy Objects With Symptoms
Only Medium Weight Objects
Only Lift Light Weight Objects
Can Not Lift At All

6 – Reading/Watching TV

No Problems
Only In The Right Position
Can, But With Symptoms
Symptoms Limit This
Symptoms Do Not Allow This

7 – Housework/Working

Usual Work Without Symptoms
Usual Work With Extra Neck Pain Symptoms
Only Half Usual Work
Only 1/4 Usual Work
Can Not Work At All

8 – Social Activity

Not Affected By Neck Pain Symptoms
Normal, But With Extra Pain
Symptoms Limit Social Life
Social Activity Only At Home
No Social Life Due To Symptoms

9 – Driving

No Problem Driving Or Do Not Drive
Can Drive But With Extra Pain Symtoms
Symptoms Limit Driving Sometimes
Symptoms Limit Driving Frequently
Can Not Drive Due To Neck Pain Symptoms




This form is designed to be quick and easy. Scores range from 0 to 108 and this is what you want to record and compare to a later date to determine if there has been improvement in how your neck pain symptoms are affecting your daily life activities. It is not a strict measure of symptom level, but how it directly affects your life. The initial score may be compared with a score from a later date to see if your condition is improving, staying about the same or getting worse. It can be used weekly or monthly depending on different methods used to deal with the issue. The categories are general to give an approximation regarding a descriptive level of how your neck pain symptoms affect daily activities, however, this will not be as variable as the actual score. The actual score will give a better interpretation regarding changes, while the descriptive level will change less over time, but indicates greater change in daily activity ability.

We also have a Neck Disability Index in an online questionnaire designed to help understand how much your neck pain is causing disability. This is also a working form to get immediate results.