OSWESTERY PAIN INDEX FORM
Patients Name__________________________________________ Date_____________ Birth Date ______________
Visit Type__________________________________________
The following questions will give us better picture about the pain you are experiencing. In your everyday life. Please mark
ONLY ONE box in each box that applies to you. Please mark the box which MOST CLOSELY describes you.
Section 1 – Pain Intensity
□ I can tolerate the pain without having to use
painkillers
□ The pain is bad but I can manage without
painkillers
□ Painkillers give complete relief from pain
□ Painkillers give moderate relief from pain
□ Painkillers give very little relief from pain
□ Painkillers have no effect on the pain and I do
not use them
Section 2 – Personal Care (Washing, Dressing, etc.)
□ I can look after myself normally without causing
extra pain
□ I can look after myself normally BUT it causes
extra pain
□ It is painful to look after myself and I am slow
and careful
□ I need some help but manage most of my
personal care
□ I need help every day in most aspect of self-care
□ I do not get dressed, I wash with difficulty and
stay in bed
SECTION 3 – Lifting
□ I can lift heavy weights without extra pain.
□ I can lift heavy weights, BUT it causes extra
pain.
□ Pain prevents me from lifting heavy weights off
the floor, but I can manage if they are
conveniently positioned, for example, on a table.
□ Pain prevents me from lifting heavy weights, but
I can manage light to medium weights if they are
conveniently positioned.
□ I can only lift very light weights, at the most.
□ I cannot lift or carry anything at all
Procedure__________________________________
Section 4 – Walking
□ Pain does not prevent me from walking any
distance.
□ Pain prevents me from walking more than 1
mile.
□ Pain prevents me from walking more than one-
half mile.
□ Pain prevents me from walking more than one-
quarter mile.
□ I can only walk using a stick or crutches
□ I am in bed most of the times and have to crawl
to the toilet.
Section 5- Sitting
□ I can sit in any chair as long as I like.
□ I can only sit in my favorite chair as long as I
like.
□ Pain prevents me from sitting more than one (1)
hour.
□ Pain prevents me from sitting more than 30
minutes
□ Pain prevents me from sitting more than 10
minutes
□ Pain prevents me from sitting almost all the
time.
Section 6 – Standing
□ I can stand as long as I want without pain.
□ I have some pain while standing, but it does not
increase with time.
□ I cannot stand for longer than one hour without
increasing pain.
□ I cannot stand for longer than ½ hour without
increasing pain.
□ I cannot stand for longer than ten minute
without increasing pain.
□ I avoid standing, because it increases the pain
straight away.
~PLEASE CONTINUE ON BACK~
Section 7- Sleeping Section 9- Traveling
□ I get no pain in bed. □ I get no pain while traveling.
□ I get pain in bed, but it does not prevent me □ I get some pain while traveling, but none of my
from sleeping well. usual forms of travel make it any worse.
□ Because of pain, my normal night’s sleep is □ I get extra pain while traveling, but it does not
hours compel me to seek alternative forms of travel.
□ Because of pain, my normal night’s sleep is 4 □ I get extra pain while traveling which compels
hours me to seek alternative forms of travel.
□ Because of pain, my normal night’s sleep is 2 □ Pain restricts all forms of travel.
hours □ Pain prevents all forms of travel except that
□ Pain prevents me from sleeping at all. done lying down.

Section 8- Social Life Section 10- Changing Degree of Pain

□ My social life is normal and give me no pain. □ My pain is rapidly getting better.
□ My social life is normal, but increases the degree □ My pain fluctuates, but overall is definitely
of my pain. getting better.
□ Pain has no significant effect on my social life □ My pain seems to be getting better, but
apart from limiting my more energetic interests, improvement is slow at present.
my dancing, golfing, jogging, etc. □ My pain is neither getting better nor worse.
□ Pain has restricted my social life and I do not go □ My pain is gradually worsening.
out very often. □ My pain is rapidly worsening.
□ Pain has restricted my social life to my home.
□ I have hardly any social life because of the pain.

Section 11: Please mark where would you rate your pain at TODAY:

NO PAIN (0) Unbearable Pain (100)

OFFICE USE ONLY:

Section 1:____ Section 2:____ Section 3:____ Section 4:____ Section 5:_____

Section 6:____ Section 7:____ Section 8:____ Section 9:____ Section 10:____

TOTAL Points: ______ TOTAL Percentage (PointsX2 / 100):______

INTERPRETATION OF DISABILITY SCORES

0 – 20% Minimal Disability: Can cope with most ADL’s. Usually no treatment needed, apart from advice on lifting, sitting, posture,
physical fitness and diet. In this group, some patients have particular difficulty with sitting and this may be important if their
occupation is sedentary (typist, driver, etc.)
21 – 40% Moderate Disability: This group experiences more pain and problems with sitting, lifting and standing. Travel and social
life are more difficult and they may well be off work. Personal care, sexual activity and sleeping are not grossly affected, and the back
condition can usually be managed by conservative means.
41 – 60% Severe Disability: Pain remains the main problem in this group of patients by travel, personal care, social life, sexual
activity and sleep are also affected. These patients require detailed investigation.
61 – 80% Crippled: Back pain impinges on all aspects of these patients’ lives both at home and at work. Positive intervention is
required.
81 – 100%: These patients are either bed-bound or exaggerating their symptoms. This can be evaluated by careful observation of the
patient during the medical examination.