Patient Pain Assessment Form

Pain is an unpleasant sensation apparently, that indicates that something somewhere is wrong in the body. However, as repulsive as it may seem, it is literally a lifesaver in some cases. It is a natural way to urge a person to seek medical advice. 

Types of Pain

Pain can be classified into two types; acute pain and chronic pain. Acute pain occurs suddenly and usually occurs following an injury. It may be treated by managing the underlying injury. However, chronic pain persists for weeks to months or years and is associated with chronic illnesses. There is another type of pain; acute on chronic pain, which is when a new pain stimulus is superimposed on previous pain caused by a chronic illness.

Pain can occur in any part of the body and everybody has experienced it in their lives. The nature of pain can describe the cause of pain. Pain is described as pricking, aching, sharp, dull, throbbing, stabbing, pinching, tingling or burning in nature.

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Pain may be classified as:

  1. Nociceptive: It is the normal response to obnoxious stimuli. It may be somatic (muscular, joint or cutaneous pain) or visceral (pain involving organs).
  2. Neuropathic: It is the pain that originates due to any abnormality in the nervous system, for example, diabetic neuropathy.
  3. Inflammatory: It is the type of pain that occurs in response to inflammation that is due to injury or infection.

Grading Pain Intensity:

Pain is graded according to the intensity into mild, moderate and severe forms. Pain severity is classified by the Stanford Pain Scale where 0 describes no pain and 10 shows that the patient is unable to move. 1 is for minimal pain, 2 for mild, 3 for discomfort, and 4 is for moderate pain. When the patient is distracted because of his pain it is described by score 5, 6 is for distressing pain which makes the patient give up his work. When the pain is unmanageable, the score is 7, 8 for intense and 9 for severe pain; in which all the patient could think of is his pain.

Patient Pain Assessment Form

There are various methods to quantify pain. They help in treating the pathology behind. A mild pain killer might not be helpful in excruciating pain. On the contrary, mild pain does not require narcotic analgesics. The essentials of patient pain assessment form are:

  • Information of patient: name, age, sex, father’s name, address, contact number, and email address.
  • History of current and past medical conditions, drugs, allergies, surgeries, family history and findings of clinical examination.
  • A referring physician with credentials.
  • Pain scale.
  • Description of pain in terms of onset, severity, radiation, patterns, duration, site, associated factors, relieving and aggravating factors.
  • The tolerance level of pain, worst pain, best pain, effects of pain, limitations, and disabilities.
  • Patient’s goal for pain control.
  • Privacy and confidentiality agreement.
  • Full name and signature of patient. Date, location and time of filling the form.


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Simi Karton

Dr. Simi Karton is a regular contributor to National Science Quarterly and an enthusiastic Lakers fan. She recently collaborated on a manuscript with friends and colleagues. Dr. Simi Karton, entitled Parkinsons and the Genetic Response to Eastern Medicine, in which she and Dr. Inshal presented research compiled during a summer spent in United States. She currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health related information stuff at an easy approach. The information has been collected from different sources at one place.

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