The following questionnaire has been designed to help you know if you may have TMS. Answer each of the seven questions and score yourself. Seven or more points is highly probable for TMS, four to six points possibly TMS. Three or fewer points probably NOT TMS. Of course a questionnaire can not replace a detailed medical history, examination, and review of x-rays and MRI scans. The diagnosis of TMS should be made by a medical doctor with expertise in this condition who examines you in the office. Use this as a guide only.
Dr. Schechter is continuing to develop and modify this questionnaire. If you are a psychologist, grad student, or other individual who has interest/expertise in this type of tool, please call his office. A PDF VERSION is available
The questionnaire is as follows:
Q.1) Have you noticed a temporal relationship between your pain and youremotional state/stress level just prior to the onset/flareup of pain?
Definitely_________ (2) Yes, have noticed this, at times_______ (1)Not really__________ Q.2) Would you describe yourself as in general, "very hard on yourself","highly responsible for others", or "very thorough, orderly, or perfectionistic"?
Definitely_____ (2)Yes, have noticed that I have some of these characteristics_____ (1)Not really_________ Q.3)Have you suffered from other tension-related illnesses such as" --hives, eczema, rashes brought on by tension --spastic colon, irritable bowel, gastritis, reflux/heartburn --tension or migraine headaches --unexplained prostate trouble or pelvic pain Definitely, two or more categories______ (2) Yes, at least one______ (1)No_________ Q.4) Have you been told regarding the cause of your pain that "there'snothing that can be done surgically", "there's nothing wrong", "it's a
soft tissue problem", or "the cause is degenerative changes"?
Yes____ (1)No_____ Q.5) Do you spend a fair amount time during the day thinking and worrying about your pain, researching an answer, obsessing about its cause?
Yes____ (1)No____ Q.6)Have you tried several different treatments or approaches for your pain and received only temporary or limited relief from each of them?
Yes__________ (1)No_________ Q.7) Do you find that massage helps your pain significantly OR that you are quite sensitive to massage in several parts of our back or neck?
Yes_____ (1)No_____ The scoring system is two points for any Definitely answer, one point foreach Yes answer and zero points for any no answers. Total the points
(based on preliminary data, the following scoring system has been developed): 7-10 points--probable TMS4-6 points--possible TMS0-3 points--unlikely to be TMS Additional questions (don't score these): Q.8) Does the pain ever move to another location or jump around? Yes ____No_____ Q.9) Have you noticed the pain improve when you have another tension-related illness? Yes____No_____ Q.10) Has the pain significantly changed or gone away while on vacation, away from home, or while distracted? Yes_____No______ PDF VERSION is easier to print out.
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