1.Have you been diagnosed with interstitial cystitis or bladder pain syndrome?

Yes

No

2.Do you struggle with bladder or pelvic pain?

yes

no

3.How frequently do you experience pain?

Hourly

Daily

Once A Week

Once A Month

Once or Twice A Year

4.How does your pain affect your daily life?

It is very mild. It doesn't interfere with my day nor dominate my thoughts. 

It is mild. I can still work and/or do my daily tasks but I'm aware of the pain

It is moderate. It stops me from doing the work that I need to do. I often have to stay home.

It is severe. It rarely leave my home because the pain is so intense

5.Was your urologist willing to provide pain treatment?

Yes, they believed that I was in pain and provided me with a prescription for an opiate medication

Yes, they believed that I was in pain but would only recommend non-opiate pain therapy 

No. I was referred to a pain specialist or my primary care provider

No. They provided no suggestions on where I should go for pain treatment