I have been discharged from primary care because of my need for pain support and I am concerned about my level of functioning or independence. I have been discharged from primary care because of my need for pain support and I am concerned about my level of functioning or independence. No I have been discharged from primary care because of my need for pain support and I am concerned about my level of functioning or independence. Yes I have been discharged from primary care because of my need for pain support and I am concerned about my level of functioning or independence. See my comments

I have been discharged from pain management care and I am concerned about the current levels of care on my functioning and independence. I have been discharged from pain management care and I am concerned about the current levels of care on my functioning and independence. No I have been discharged from pain management care and I am concerned about the current levels of care on my functioning and independence. Yes I have been discharged from pain management care and I am concerned about the current levels of care on my functioning and independence. See my comments

I am using over the counter medications (OTCs) to help reduce pain. I am using over the counter medications (OTCs) to help reduce pain. No I am using over the counter medications (OTCs) to help reduce pain. Yes I am using over the counter medications (OTCs) to help reduce pain. See my comments

The reduction in pain care has increased my use of alcohol or tobacco to control pain levels. The reduction in pain care has increased my use of alcohol or tobacco to control pain levels. No The reduction in pain care has increased my use of alcohol or tobacco to control pain levels. Yes The reduction in pain care has increased my use of alcohol or tobacco to control pain levels. See my comments

The loss of pain care has resulted in feelings of hoplessness and/or increased my consideration of suicide. The loss of pain care has resulted in feelings of hoplessness and/or increased my consideration of suicide. No The loss of pain care has resulted in feelings of hoplessness and/or increased my consideration of suicide. Yes The loss of pain care has resulted in feelings of hoplessness and/or increased my consideration of suicide. See my comments

I have borrowed or considered borrowing medications from friends or family to address my pain levels. I have borrowed or considered borrowing medications from friends or family to address my pain levels. No I have borrowed or considered borrowing medications from friends or family to address my pain levels. Yes I have borrowed or considered borrowing medications from friends or family to address my pain levels. See my comments

I have used or are considered the use of street drugs to address my untreated pain levels. I have used or are considered the use of street drugs to address my untreated pain levels. No I have used or are considered the use of street drugs to address my untreated pain levels. Yes I have used or are considered the use of street drugs to address my untreated pain levels. See my comments

The discharge from pain care resulted in a decline in my health status. The discharge from pain care resulted in a decline in my health status. No The discharge from pain care resulted in a decline in my health status. Yes The discharge from pain care resulted in a decline in my health status. See my comments

The discharge from pain care has added extra stress or burden to my daily life The discharge from pain care has added extra stress or burden to my daily life No The discharge from pain care has added extra stress or burden to my daily life Yes The discharge from pain care has added extra stress or burden to my daily life See my comments

My family life is negatively affected by my loss of access to pain care. My family life is negatively affected by my loss of access to pain care. No My family life is negatively affected by my loss of access to pain care. Yes My family life is negatively affected by my loss of access to pain care. See my comments

I have refused some services that I felt were not appropriate for my needs (comments) I have refused some services that I felt were not appropriate for my needs (comments) No I have refused some services that I felt were not appropriate for my needs (comments) Yes I have refused some services that I felt were not appropriate for my needs (comments) See my comments

I have been told that I must accept services I do not want in order to get services that I need I have been told that I must accept services I do not want in order to get services that I need No I have been told that I must accept services I do not want in order to get services that I need Yes I have been told that I must accept services I do not want in order to get services that I need See my comments

My refusal of unwanted services resulted in my discharge from primary care, pain management, or other services. My refusal of unwanted services resulted in my discharge from primary care, pain management, or other services. No My refusal of unwanted services resulted in my discharge from primary care, pain management, or other services. Yes My refusal of unwanted services resulted in my discharge from primary care, pain management, or other services. See my comments