Patient Pain Assessment Form

Pain is an unpleasant sensation that indicates that something is wrong somewhere in the body. However, as repulsive as it may seem, it is 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, 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.

Pain may be classified as:

  1. Nociceptive: This 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.


Pain Assessment Form

Pain Assessment Form Size: 72 KB

Grading Pain Intensity

Pain is graded according to 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 is for mild pain, 3 is for discomfort, and 4 is for moderate pain. When the patient is distracted because of his pain, it is described by a score of 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 them. A mild painkiller might not be helpful in excruciating pain. On the contrary, mild pain does not require narcotic analgesics. The essentials of the patient pain assessment form are:

  • Information about the 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 factors, 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 the patient. Date, location, and time of filling out the form.

You may also like...