Tell Your Story

Welcome to the Your Voice Matters story submission form.

We're so glad you're here because your voice matters! You are affecting policy decisions and new areas of research. Your responses will be combined with others and hand-delivered to Members of Congress between June 14-18. Letters received after that date will be delivered on bi-monthly intervals. (Your address is needed by congressional offices to verify you as their consituent.) To be effective, we estimate that 10,000 responses will be representative of how chronic pain affects people’s lives in the United States. Together we make a difference!

The prompts below are available for you to tell your story as fully as you wish. We invite you to answer the questions you want to and appreciate your support!

***Important: Please type your responses in a word processor and copy and paste into the form below. We have received several reports of "Timed Out" Submissions, which are then lost. We appreciate your time and effort in telling your story.

Required *

First Name

Last Name

Email Address

A photo helps bring your story to life. This photo will be shared with your story if you choose to upload one.

If you have a letter that's written, we invite you to upload it here.

Current Diagnosis (Primary & Secondary)

Are you unable to work productively or to the level you'd like? If so, how?

Are you having a hard time getting through your day because pain stops you? If so, how?

Are you avoiding medical appointments due to expense? If so, why?

Can you get appropriate medications or treatments for pain relief? Has that access changed over time? If so, how?

What obstacles prevent you from finding appropriate access to pain care, if any?

Have you disclosed your full diagnosis or experience with your chronic pain illness with those around you? If so, who? (Ex. Friends, family, co-workers, boss, etc.) If not, why?

Has your chronic pain illness affected your ability to work or your productivity? If so, how?

Has your chronic pain illness affected your education or career goals? If so, how?

Does chronic pain limit the activities you love most? If so, how?

Are you unable to participate in family or social activities? If so, how?

Are you hiding anxiety or feeling depressed about what the future holds with a chronic pain condition? If so, how?

Are you experiencing suicidal thoughts from fear or exhaustion in dealing with constant pain? If so, why?

Are you feeling that you have to defend your actions in seeking pain relief? If so, how?

What led you to seek a diagnosis, and what led a clinician to diagnose you? Were there any hurdles in achieving a diagnosis? If so, what?

Feel free to share anything else about your experiences with a chronic pain illness.

Birthdate (DD.MM.YEAR)

Address

City

State

Zip Code

I agree to the Terms and Conditions.

Tell Your Story

Please CLICK HERE to review the terms and conditions.