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Where does it hurt?

Not all aches and pains are created equal. Some disappear as quickly (and mysteriously) as they came. Others can lead to sleepless nights or time off work. But managing your pain symptoms may mean being precise.

Use this form to help pinpoint and describe your tender spots. Print this out, circle the area of your body where you feel pain, and complete the questions to help you understand and describe your pain.

pain

What type of pain do you feel here?

Burning
Discomfort
Dull
Numb
Sharp
Shooting
Stabbing
Tender
Throbbing
Tingling

How severe is the pain you feel?

1 — Very mild (I can perform all of my daily activities without problems)
2 — Mild (I usually feel it only when I think about it)
3 — Moderate (I cannot perform some of my daily activities)
4 — Severe (I cannot perform most of my daily activities)
5 — Very Severe (I cannot perform any of my daily activities)
6 — Intense/Relentless (The pain is overwhelming and is all that I feel)

 

When did the pain start?

In the last 24 hours
1-3 days ago
3-7 days ago
Over a week ago

 

When is the pain at its worse?

__________________________________________

__________________________________________

 

When is the pain at its mildest?

__________________________________________

__________________________________________

 

If you know, what caused the pain to begin with?

__________________________________________

__________________________________________

 

What makes the pain worse?

__________________________________________

__________________________________________

 

What makes the pain better?

__________________________________________

__________________________________________

 

Has the pain caused other symptoms? (For example, loss of sleep or appetite, fatigue.)

__________________________________________

__________________________________________

 

What have you tried to alleviate the pain? (For example, compresses or over-the-counter medication.)

__________________________________________

__________________________________________

 

Where does it hurt?