My Pain

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Age*

Please enter a number less than or equal to 110.

Gender*

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Female

The International Association for the Study of Pain (IASP) defines pain as:

An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is not just a physical sensation. It is influenced by attitudes, beliefs, personality and social factors, and can affect emotional and mental wellbeing. Although two people may have the same pain condition, their experience of living with pain can be vastly different. For more details https://www.painaustralia.org.au/about-pain/what-is-pain

The main location of your pain*

Please describe where you feel your pain. Where is your pain the 'Loudest'?

ONE word to describe your pain*

If you had to descirbe your pain in one word, what would word would you choose?

Now please expand on that word.*

Describe the pain eg: is it aching, sharp, deep, shooting?

Does the pain move anywhere?*

Are you aware of the pain radiating to any other part of your body?

What is is like on a general daily basis?*

Tell me about the worst pain or soreness, average pain/soreness, pain/ soreness with movement.

What is is like right NOW?*

Please tell me what your pain is like in this moment, the first words that come to your mind even if it doesn't seem to make sense on paper.

Are you currently seeing a doctor or a health professional in regard to the pain you are experiencing?*

Yes
No

Has your pain been diagnosed as acute pain, chronic pain, or cancer Pain?*

Yes
No

*

Acute Pain
Chronic Pain
Cancer Pain

Does your pain stop you from doing anything?*

Please describe the issues your pain creates in your life, or the restrictions that you experience as a result of the pain you are experiencing.

Please name just one area of your life that you know has been affected because of your pain.*

If you were not dealing with pain, what would you be able to do, or where would you be now?*

Describe how you see your life if your pain was gone?

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The International Association for the Study of Pain (IASP) defines pain as:

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