How does the pain feel? (sharp, dull, aching, burning, squeezing, pressure, cramping, etc.)

 

 

Where is the pain? Is it in more than one site?

 

 

What is the present and past intensity of the pain, at its worst and at its best?  How often does it occur?  Is it consistent or intermittent? When did it begin?
 


Numerical Rating Scale

 

 

Current Pain

 

 

 

 

Pain Over Past Week

 

 

 

 

Wong-Baker FACES Pain Rating Scale


The Wong-Baker FACES Pain Rating Scale is commonly used with persons age 3 years and older. It can be used with children or in cases where there is a language barrier. When using the scale it is helpful to point to each face using the words to describe the pain intensity. Healthcare practitioners usually record the number corresponding to the face chosen.

 

 

What makes the pain worse?

 

 

What makes the pain better? What pharmacological and non-pharmacological approaches (including complementary or alternative therapies) have been and are being used for the treatment of pain? Were they and are they effective?

 

 

What side effects were/are experienced from past and present analgesics?  How does pain affect quality of life - physical, psychological and social functioning?

 

 

BRIEF SCREENING PSYCHOLOGICAL ASSESSMENT

How has your mood (depression or anxiety) affected your daily functioning?

 

 

Do you have enough energy to accomplish things during the day?

 

 

Do you ever feel like giving up?

 

 

How have others around you reacted to your pain?

 

 

 
This sample pain assessment employs commonly used pain scales and questions. Basic assessment is a critical part of total pain management. This sample pain assessment demonstrates the questions that can aid healthcare practitioners in completing a thorough pain assessment.