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PEG-3 (NM800132)

PEG-3 (NM800132) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires



Patient Name

DOB:

MR #



NM800132 (Rev. 01/31/18) Worksheet Only – Not a Medical Record Document, DO NOT SCAN

UW Health
(University of Wisconsin Hospitals and Clinics Authority)
PEG-3
PEG 3 item pain scale



Interview version:
1. What number best describes your pain on average in the past week, on a scale from 0 to 10 where 0 is “no
pain” and 10 is “pain as bad as you can imagine”? [0 to 10]
The following two questions ask you to describe how, during the past week, pain has interfered with your life on
a “0 to 10” scale, where 0 is “does not interfere at all” and 10 is “completely interferes.”
2. What number best describes how, during the past week, pain has interfered with your enjoyment of
life? [0 to 10]
3. What number best describes how, during the past week, pain has interfered with your general activity? [0 to
10]
Scoring: The PEG score is the average of the 3 individual item scores. For clinical use, round to the nearest
whole number.






Krebs EE, Lorenz KA, Bair MJ, Damush TA, Wu J, Sutherland JM, Asch SM, Kroenke K. Development and initial validation of the PEG, a
3-item scale assessing pain intensity and interference. Journal of General Internal Medicine. 2009 Jun;24:733-738.