User Generated Form

Pain Assessment Questionnaire Template

Are you a professional helping clients who are dealing with pain? If so, you know how difficult it can be to accurately assess the source and severity of the pain. That's why we've created this Pain Assessment Questionnaire Template to help you quickly and accurately assess the type and intensity of pain your client is experiencing.


This template is designed to be simple and straightforward to use. It contains questions designed to get to the root of the issue, such as where the pain is located, what makes it worse, and what makes it better. It also includes questions about the physical characteristics of the pain and its intensity.


The Pain Assessment Questionnaire Template is a great tool for any professional working with clients who are dealing with pain. It will help you quickly and accurately assess the type and intensity of pain your client is experiencing and provide you with the information you need to determine the best treatment plan.

Pain Assessment Questionnaire Template

  1. When did the pain start? What were you doing when it started?
  2. Was the onset of pain sudden, gradual or part of an existing condition?
  3. Has the pain changed in any way since it began? (better/worse/different symptoms)? Have you experienced this pain before if so when?
  4. Is it localized to one area or does it radiate anywhere else?
  5. Do certain activities or movements or positions make the pain better or worse? E.g. walking, standing still, lifting, reading etc.
  6. Do any other interventions assist with the pain? E.g. hot/ice packs, topical creams, acupuncture, massage etc.
  7. The pain is...
  8. Does the weather affect your pain, if so, what kind? E.g. hot, dry, damp, humid, rainy etc.

  9. Does the pain impact your energy levels or mood?
  10. Certain foods are considered “inflammatory”, while others may cause inflammation if you have a sensitivity to them. This can add to the body’s overall pain burden. Do any foods trigger the pain or make it worse?

  11. How often do you exercise a week? Exercise includes moderate activity including brisk walking, gym, pilates, yoga, swimming or hiking..
  12. Does the weather affect your pain, if so, what kind? E.g. hot, dry, damp, humid, rainy etc.

  13. Does your job involve hard physical activity, heavy lifting or repetitive tasks?
Try Practice for free

Related Forms

No items found.