To decrease your pain how much would you be willing to: (circle your effort)

1 Exercise

0 1 2 3 4 5 6 7 8 9 10

2 Water Aerobics/Pool Therapy 0 1 2 3 4 5 6 7 8 9 10

3 Stretching 0 1 2 3 4 5 6 7 8 9 10

4 Attend Pain Education Groups 0 1 2 3 4 5 6 7 8 9 10

5 Use a TENS Unit 0 1 2 3 4 5 6 7 8 9 10

6 Lose Weight (If Applicable) 0 1 2 3 4 5 6 7 8 9 10

7 Stop Smoking (If Applicable) 0 1 2 3 4 5 6 7 8 9 10

8 Do Physical Therapy 0 1 2 3 4 5 6 7 8 9 10

9 Learn New Leisure Interests 0 1 2 3 4 5 6 7 8 9 10

10 Increase Activity Level 0 1 2 3 4 5 6 7 8 9 10

11 Screening or Treatment for Addiction (If Applicable)

0 1 2 3 4 5 6 7 8 9 10

12 Decrease Pain Medication (If Applicable) 0 1 2 3 4 5 6 7 8 9 10

13 Stop Using Alcohol or Drugs (If Applicable) 0 1 2 3 4 5 6 7 8 9 10

14 Use Relaxation Therapy 0 1 2 3 4 5 6 7 8 9 10

15 Get Treatment for Anger, Depression, Anxiety 0 1 2 3 4 5 6 7 8 9 10

16 Learn Communication Skills 0 1 2 3 4 5 6 7 8 9 10

17 Do Yoga, Tai Chi, or other Meditative Techniques 0 1 2 3 4 5 6 7 8 9 10

18 Join an Activity Group 0 1 2 3 4 5 6 7 8 9 10

19 Try Acupuncture 0 1 2 3 4 5 6 7 8 9 10

20 Try Medical Marijuana 0 1 2 3 4 5 6 7 8 9 10

21 Try Chiropractic 0 1 2 3 4 5 6 7 8 9 10