Final Op Pain Questions Marking Sheet

Massage Theory and Techniques 1 Pain Questions Marking Sheet Therapist’s Name _________________________

Examiner ___________________

Onset When did the pain begin?

____

Location Where is the pain?

____

Referral or Radiation Does it move or refer to other areas

____

Quality Can you describe the pain?

____

Quantity How painful is it, mild moderate or severe? Scale 1-10

____

Duration How long does it last?

____

Frequency How often does it occur?

____

Relief What makes it better?

____

Aggravates What makes it worse?

____

Other symptoms Are there any other symptoms associated with the pain?

____

Anything else to add Is there anything that was missed or the client would like to add?

____

Total

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