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

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

Result - Copy and paste this output: