| 1. What is your gender? |
| Female (93.5%) |
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| Male (6.5%) |
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| 2. What is your age? |
| Under 21 (2.5%) |
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| 21 - 30 (19.3%) |
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| 31 - 40 (26.0%) |
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| 41 - 50 (28.1%) |
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| 51 - 60 (15.7%) |
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| 61 - 70 (5.7%) |
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| 71 - 80 (2.5%) |
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| Over 80 (0.4%) |
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| 3. Have you been diagnosed with IC? |
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3b. If no, do you experience the symptoms of IC (pain, urinary frequency and urgency), but have never been officially diagnosed? |
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| 4. How would you describe the level of your pain? |
| Mild (6.1%) |
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| Moderate (19.7%) |
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| Severe (33.2%) |
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| Varies (41.1%) |
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| 5. Does the level of your pain vary from day to day, or does it remain at a constant level? |
| Varies from day to day (84.3%) |
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| Remains at a constant level (15.7%) |
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| 6. Do you feel that your treating physician takes your IC pain seriously? |
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| 7. Do you feel that your IC pain is being treated inadequately? |
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| 8. Have you ever been prescribed pain medications, also known as opioid or narcotic analgesics, (Tylenol #3, Vicodin, Percocet, codeine, morphine, etc.) for the treatment of your IC on either a short-term or long-term basis? |
| Yes, on a short-term basis (27.8%) |
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| Yes, on a long-term basis (14.8%) |
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| Yes, on both a short- and long-term basis (20.1%) |
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| No (37.3%) |
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| 9. If you are taking prescription pain medication, are you receiving this prescription through your treating physician or a pain clinic? |
| Through my treating physician (78.3%) |
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| Through a pain clinic (12.6%) |
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| Other source (9.1%) |
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| 10. If you are taking prescription pain medication, did you find that your physician was reluctant to prescribe these medications to you? |
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10a. If yes, do you feel that you needed pain medications, but that your treating physician was not willing to prescribe them to you? |
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10b. If no, was your physician willing to prescribe pain medications to you on an ongoing basis to be used as needed for your IC pain/flares? |
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| 11. If your physician was not willing to prescribe pain medication to you, did he or she refer you to a pain clinic? |
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11a. If yes, was the pain management specialist at the pain clinic able to help you to reduce your pain using prescription pain medications? |
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| 12. Have you ever been prescribed long-acting formulations of opioids, such as MS-Contin, methadone or Oxycontin to treat the pain of your IC? |
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| 13. Have you ever been prescribed a pain patch, pump, or other non-oral narcotic device to help you with your IC pain (such as the transdermal Fentanyl Patch, rectal suppositories such as B & O suppositories, infusion pumps that deliver pain medication to the spine, etc.)? |
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