Contento Health : Your Pain in Personal

1Sleep, Energy and Concentration

  • How many hours do you sleep a night on average?*

  • Do you have enough energy?*

  • Do you have problems concentrating or focusing?*

2Health (including pain symptoms and overall health)

The PEG is a validated screen to measure the impact of pain. The PEG score is most useful in tracking changes over time. [PMID 19418100] The PEG score should decrease over time after therapy has begun.

The least amount of pain you can Imagine =0 and the most you can imagine =10.

  • What is your highest pain level over the past week?*

  • What number best describes how, during the past week, pain has interfered with your enjoyment of life?*

  • What number best describes how, during the past week, pain has interfered with your general activity?

  • Have you EVER been told by a doctor or other health professional that you had*

  • Do you use cannabis to help with any of these conditions

  • Which health aspects of your conditions are most bothersome to you?*

3Anxiety and Depression: Over the past two weeks, how often have you been bothered by the following symptoms?

The PHQ-4 an evidence based assessment for anxiety and depression. The PHQ score, like most other screening instruments, is most useful in tracking changes over time. The PHQ score should decrease over time as symptoms improve. PHQ-4 risk score is rated as normal (0-2), mild (3-5), moderate (6-8), and severe (9-12). Total score ?3 for first 2 questions suggests anxiety. Total score ?3 for last 2 questions suggests depression.

0 No or Low Risk

1 Low score

2 Moderate risk of condition

3 High risk of condition

  • Feeling nervous, anxious or on the edge?*

  • Not being able to stop or control worrying?*

  • Feeling down, depressed or hopeless?*

  • Little interest or pleasure in doing things?*

4Optional Information

  • Which of any of the following holistic alternatives do you use to help manage your health / pain?

  • Methods - If you use cannabis, which ways do you prefer to consume?

  • How many times have you ever used cannabis?

  • Acknowledging most marijuana labels do not highlight whether the strain is indica, hybrid or sativa which composition is your preference? Indica is more relaxing and Sativa more active.

  • I prefer - CBD / THC / Mixed?

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