Pain History

Pain History
Location: [text]
Characterized as: [text].
Radiation: [text]
Severity now (0-10): [text]
Severity at worst (0-10): [text]
Duration and timing: [text]
Provocative factors: [text]
Palliating factors: [text]

Pain beliefs/expectations:
Cause: [text size=72 memo=" <-- What is causing my pain?"]
Meaning: [text size=72 memo=" <-- Work will worsen my pain because..."]
Impact: [text size=72 memo=" <-- On my work/social/recreational/quality of life in general."]
Treatment: [text size=72 memo=" <-- What needs to be done now and in the future for my pain."]
Goals: [text size=72 memo=" <-- What I expect to achieve with treatment."]
Involvement: [text size=72 memo=" <-- How involved will I be in my treatment?"]