Pain Assessment

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Pain Relief Institute of AmericaPain Assessment

Your pain level

0 means no pain and 10 means the worst pain you can imagine.

Pain right now

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Pain at its best in the last week

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Pain at its worst in the last week

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Your average pain in the last week

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How much does pain get in the way?

0 means it does not interfere and 10 means it completely interferes.

General activity

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Mood

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Walking

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Normal work or housework

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Relationships with other people

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Sleep

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Enjoyment of life

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Comments

Anything else we should know about your pain

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