Directions: Following are some questions given to patients who are on or are being considered for medication for their pain. Please answer each question as honestly as possible. There are no right or wrong answers.
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• Phone (617) 332-6028 • Fax (617) 332-1820 • www.inflexxion.com
The Screener and Opioid Assessment for Patients with Pain was developed with a grant from the National Institutes of Health (#2R44DA015617-02)