CP/CPPS Symptom AssessmentNIH-CPSI Questionnaire1. Pain or discomfort location in the last week (check all)Perineum (between rectum and testicles)TesticlesTip of the penis (not urination)Pubic or bladder area2. Also experienced in the last week (check all)Pain/burning during urinationPain/discomfort during or after ejaculation3. How often have you had pain or discomfort?Never+0Rarely+1Sometimes+2Often+3Usually+4Always+54. Average pain intensity on days you had it (0=None, 10=Worst)012345678910Urinary Symptoms5. Sensation of not emptying bladder completely after urinatingNot at all+0< 1 in 5+1< half+2~half+3> half+4Almost always+56. Needed to urinate again less than 2 hours after urinatingNot at all+0< 1 in 5+1< half+2~half+3> half+4Almost always+5Quality of Life7. Symptoms kept you from usual activitiesNone+0A little+1Some+2A lot+38. How much did you think about your symptomsNone+0A little+1Some+2A lot+39. If you spent the rest of your life with these symptoms, how would you feel?Delighted+0Pleased+1Mostly satisfied+2Mixed+3Mostly dissatisfied+4Unhappy+5Terrible+6ClearAwaiting Responses
