Back Pain Survey

Cure-Back-Pain.Org proudly presents the official online version of the back pain survey distributed worldwide by Sensei Adam Rostocki. This survey has already been taken by over eight hundred thousand (800,000) patients who were kind enough to provide their personal experiences with back pain.

The results of this survey are an important part of the research which fuels this website. One moment of your time will help other patients to cure their own pain.

Do something good for fellow patients around the globe. Share your experiences and maybe help to change a life.

No personal information acquired as part of this survey will be shared with any other entity. You will not be placed on any mailing list from your participation in this survey. The only email you will receive is a confirmation of your participation.

Please be honest and accurate with your survey.

Your results are important.

This is your chance to make a real difference in the way back pain is diagnosed and subsequently treated.

Thank you for your time and contribution.


BACK PAIN SURVEY

Please note that all fields followed by an asterisk must be filled in.
Female
Male
Under 18
18 to 25
26 to 35
36 to 45
46 to 55
56 to 65
66 to 75
over 76
Degenerative Disc Disease
Facet Joint Syndrome
Fibromyalgia
Herniated Disc
Kyphosis
Lordosis
Muscle Problems
Pinched Nerve/Foraminal Stenosis
Piriformis Syndrome
Sacroiliac Joint Dysfunction
Sciatica
Scoliosis
Spinal Arthritis
Spinal Stenosis
Spondylolisthesis
TMS/Psychosomatic
Neck
Upper Back
Middle Back
Lower Back
Buttocks
Legs
Feet
Shoulder
Arms
Hands
Hips/Pelvis
Less than 3 months
Less than 6 months
Less than 1 year
1 to 3 years
3 to 10 years
10 to 20 years
20 years or more
Once
A Few Isolated Occurrences
Occasional
Somewhat Frequent
Frequent
Regular
Almost Constant
Always
Annoying
Mild
Moderate
Severe
Extreme
Beyond Measure
Acupuncture
Alexander Technique
Alternative Medicine (specify below)
Chiropractic
Complementary Medicine (specify below)
Dietary Therapy
Drugs/Medicines
Electrotherapy/TENS
Epidural Injections
Knowledge Therapy
Physical Therapy
Spinal Decompression
Surgery (outpatient minimally invasive)
Surgery (full procedure)
Other (specify below)
No
Yes
I am completely well
I still have a little pain
I have occasional moderate pain
I have constant moderate pain
I have occasional severe pain
I have constant severe pain
I have occasional extreme pain
I have chronic extreme pain
None
Minor Effect
Moderate Effect
Significant Effect
Severe Effect
It Controls My Life
No
A Little
Somewhat Helpful
Very Helpful
Super Helpful


Once again, thank you for taking the back pain survey.

You might also be interested in sharing your back pain story with us.

Thank you also to the many volunteers who continue to distribute the paper version of this survey. Your diligent work is much appreciated.



Back Pain > Back Pain Survey