Abdominal Wall Pain Questionnaire

Abdominal Wall Pain Questionnaire
1. How often do you experience bloating or a feeling of gas in the intestines? [select name="variable_1" value="Mostly=0|Regularly=0|Sometimes=1|Never=1"]
2. Does pain exist on different spots all over the abdomen? [select name="variable_2" value="Yes=0|No=1"]
3. Does pain dominate over discomfort? [select name="variable_3" value="Yes=1|No=0"]
4. How often do you have pain when lying on the affected side? [select name="variable_4" value="Mostly=1|Regularly=1|Sometimes=0|Never=0"]
5. How often does the stool have an abnormal consistency (e.g., hard and small, pencil thin, loose, watery)? [select name="variable_5" value="Mostly=0|Regularly=0|Sometimes=1|Never=1"]
6. Does it feel like the pain originates just beneath the skin? [select name="variable_6" value="Yes=1|No=0"]
7. How often do you have sharp pain? [select name="variable_7" value="Mostly=1|Regularly=1|Sometimes=0|Never=0"]
8. Does it feel like the pain originates from the gastrointestinal tract? [select name="variable_8" value="Yes=0|No=1"]
9. How often do you feel an urgent need for bowel movement without producing stool (incomplete defecation)? [select name="variable_9" value="Mostly=0|Regularly=0|Sometimes=1|Never=1"]
10. How often do you have pain when coughing, sneezing, or squeezing? [select name="variable_10" value="Mostly=1|Regularly=1|Sometimes=0|Never=0"]
11. Is the pain always located in the same spot? [select name="variable_11" value="Yes=1|No=0"]
12. Is the pain just lateral to the midline of the abdomen? [select name="variable_12" value="Yes=1|No=0"] <--
13. Is the pain related to an altered defecation pattern? [select name="variable_13" value="Yes=0|No=1"]
14. How often do you have pain with daily activities (e.g., walking, sitting, cycling, bending)? [select name="variable_14" value="Mostly=1|Regularly=1|Sometimes=0|Never=0"]
15. How often does the painful spot feel strange, different, or dull? [select name="variable_15" value="Mostly=1|Regularly=1|Sometimes=0|Never=0"]
16. How often does stress provoke the pain? [select name="variable_16" value="Mostly=0|Regularly=0|Sometimes=1|Never=1"]
17. Can you show with the tip of your finger where the most intense pain is? [select name="variable_17" value="Yes=1|No=0"]
18. How often do you have pain when pushing on the tender spot? [select name="variable_18" value="Mostly=1|Regularly=1|Sometimes=0|Never=0"]
Score --> [calc memo="number" value="(variable_1)+(variable_2)+(variable_3)+(variable_4)+(variable_5)+(variable_6)+(variable_7)+(variable_8)+(variable_9)+(variable_10)+(variable_11)+(variable_12)+(variable_13)+(variable_14)+(variable_15)+(variable_16)+(variable_17)+(variable_18)"]
A score of 10 or higher suggests diagnosis of Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) over irritable bowel syndrome with 94% sensitivity and 92% specificity.
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference:
[link url="//www.ncbi.nlm.nih.gov/pubmed/24204070" memo="#1"] van Assen T, de Jager-Kievit JW, Scheltinga MR, Roumen RM. Chronic abdominal wall pain misdiagnosed as functional abdominal pain. J Am Board Fam Med. 2013 Nov-Dec;26(6):738-44.
[/conditional]