Pain assessment form 2026

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The document is a Comprehensive Pain Assessment Form designed for evaluating and documenting an individual's pain levels, types, and effects on daily activities. It includes sections for personal information, pain intensity ratings using various scales, history of pain, factors affecting pain, medication history, and a plan for addressing pain management. The form aims to facilitate effective communication between healthcare providers regarding the patient's pain control goals and treatment strategies.

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Click ‘Get Form’ to open the pain assessment form in the editor.
Begin by entering the individual's name and ID number at the top of the form, along with the assessment date and time.
In the 'Individuals Pain Control Goal' section, check the appropriate rating on a scale from 0 to 10 that reflects their pain control goal.
Fill in the current pain-related diagnosis and select the type of pain experienced (nociceptive, neuropathic, or mixed).
Indicate any depression status and complete the 'Reason for Assessment' field, including room number if applicable.
Utilize the provided scales (Numerical, Faces Pain Scale-Revised, Verbal Descriptor Scale) to assess and circle the intensity of pain.
Mark areas of pain on the diagram provided in the form using designated symbols for different sensations.
Document history of pain onset, frequency, description, changes in pattern, causes/increases in pain, and what relieves it.
Rate how pain has affected various aspects of life over the past 24 hours using a scale from 0 to 10.
Complete any comments or additional information before signing off on the assessment with your title and date.

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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (291 Votes)

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How to document a pain assessment?

History of Pain. Onset of Pain: New (last 7 days) Recent (last 3 mos.) Frequency of Pain: Description of Pain: Aching Burning Cramping Crushing Dull Numbness. Change in Pattern of Pain: Has the pain changed in description or intensity the last 7 days? Causes/Increases in Pain: Movement Coughing Cold Heat Fatigue Anxiety.

What are the 5 Ps of pain assessment?

The 5 Ps acronym is used systematically in a neurovascular assessment to assess compartment syndromes presence. The Ps refer to pain, pallor, pulse, paresthesia, and paralysis. Pain is commonly rated on a 10-point scale and can be disproportionately severe in the case of compartment syndrome.

What are the 5 Ps of pain?

The Ps refer to pain, pallor, pulse, paresthesia, and paralysis. Pain is commonly rated on a 10-point scale and can be disproportionately severe in the case of compartment syndrome. Pallor refers to the appearance of the skin and whether it appears as though blood is appropriately docHubing the affected body part.