1. Look at the Pain Rating Scale, and rate your current pain from "no pain" to "worst pain imaginable.   (Note: Bay’s Pain Management Center uses a 0-10 pain rating scale.)
   
   
2. Check your tolerance for pain:

   ___ I can tolerate almost any pain (except for the pain I’m experiencing now)

   ___ I have a fairly high threshold for pain.

   ___ I have a moderate threshold for pain.

   ___ I have a low threshold for pain I (I don’t want to feel a thing!)

    

3. When do you experience pain?

   ___ Sitting ___ Bending (i.e., to get in a car)

   ___ Standing ___ Turning my body

   ___ Walking ___ Doing household chores

   ___ Lifting (anything above one pound) ___ Sleeping (can’t get comfortable)

   ___ Other (list activity)

4. How often do you experience pain?

   ___ Only after strenuous activity ___ Only on rare occasions

   ___ Only when I move a certain way ___ Occasionally

   ___ Every day ___ All the time

5. Where is your pain? (check all that apply):

   ____ Back ___ Lower back ____ Legs

   ____ Shoulders ___ Head ____ Abdomen

   ____ Neck ___ Arms ____ Other (list)

6. What do you currently do for pain relief?

Print this pain rating scale and take it with you when you visit your primary care physician or specialist.