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LYRICA Home Page Fibromyalgia Home Page About Fibromyalgia Possible Causes Symptoms and Diagnosis of Fibromyalgia Fibromyalgia Facts Tips to Find a Doctor Pain Questionnaire

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Pain Questionnaire These steps may help your doctor better understand what you're feeling and the kind of pain you are having. Use This Questionnaire to Make the Most Out of Your Next Visit. Print out your results. (Print-Friendly Version) Click here to request your FREE Information Kit. A copy of this helpful pain discussion guide is included! Next: About LYRICA 1. Have you been suffering from your pain for 3 months or more? Yes   2. Do you feel pain on both sides of the body? Yes   3. Do you feel pain both above and below the waist? Yes   4. In the last week, how many days have pain and fatigue interfered with your daily living? 7   5. Circle the areas of your body where you feel pain. (You can draw the circles after you have printed out your completed questionnaire.)


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6. In the last 4 weeks, has your pain interfered with the ability to do any of the following things? (Check all that apply.) Sleep Concentrate Work Take care of my family See friends Finish household chores   7. Is your pain accompanied by any of the following? (Check all that apply) Muscle tenderness Flu-like aching Dull pain in tendons and ligaments   8. What prescription medicines have you tried? (Please write in medicine names below. And rate relief for each one.) 0 = no relief                                                                  2 = some relief 1 = little relief                                                                3 = good relief Prescription none   Rate relief (0 to 3)

LYRICA is not for everyone. LYRICA may cause serious allergic reactions. Tell your doctor right away about any serious allergic reaction such as swelling of the face, mouth, lips, gums, tongue or neck or if you have any trouble breathing. Other allergic reactions may include rash, hives and blisters. Tell your doctor about any changes in your eyesight, including blurry vision, muscle pain along with a fever or tired feeling. If you have diabetes tell your doctor about any skin sores.

Some of the most common side effects of LYRICA are   dizziness,   sleepiness, weight Prescription gain, blurred vision, dry mouth, feeling   "high", swelling of   hands and feet, and Rate relief (0 to 3) trouble concentrating. You   may have a higher chance for swelling   and hives if you are also taking angiotensin converting enzyme (ACE) inhibitors so you should let your doctor know if you are taking these medications. You may have a higher chance of swelling or gaining weight if you are also taking certain diabetes medicines. You should not drive or operate machinery until you know how LYRICA affects you. Do not drink alcohol while on LYRICA. If you take medicines that make you sleepy you may feel more sleepy when you start LYRICA. Also tell your doctor if you are planning to father a child. Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you have had a drug or alcohol problem, you may be more likely to misuse LYRICA. In mice, an increase in a specific type of blood vessel tumor was observed but no evidence of the same effect was seen in studies with rats. The clinical significance of this finding is unknown. During clinical studies in humans, none of the same tumor types were observed, although some new or worsening-preexisting tumors were reported (57 patients out of 6396 patient-years). It is not possible to know whether this is or is not related to LYRICA treatment. Talk with your doctor before you stop taking LYRICA or any other prescription medication. LYRICA is one of several treatment options for you and your doctor to consider. View the Patient Product Information. View the Prescribing Information. Pfizer LYRICA Call Center for DPN and PHN Patients 1-866-4-LYRICA (1-866-459-7422) Pfizer LYRICA Call Center for Fibromyalgia Patients 1-888-5-LYRICA (1-888-559-7422)

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