Pain Assessment for Diabetic Nerve Pain

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You know that you have pain, but you may not know what's causing your pain. Sometimes, it may even be hard to describe the pain you're feeling.

The Pain Assessment Questionnaire can help you and your doctor decide if the pain you’re feeling is nerve pain. Simply answer the questions below and share your answers with your doctor.

1. I would describe my pain as: (Check all that apply.)

Pins and needles

Stabbing/shooting

Burning

Aching/throbbing

Numb

Sharp

2. My pain worsens: (Check all that apply.)

In the morning

In the afternoon

In the evening

While sleeping

3. I would rate my pain as: (Use scale below; 0=no pain, 10=worst possible pain)


0	1	2	3	4	5	6	7	8	9	10

4. My pain interferes with my ability to: (Check all that apply.)

Go up or down stairs

Get in or out of a car

Get in or out of bed

Play with kids/grandkids

Perform heavy chores

Sleep

Perform daily activities such as shopping

5. I am taking or have taken medication for my pain:

Yes

6. If yes, the medicine(s):

Help(s) me with my pain

Do(es) not help me with my pain

Help(s) for a time, then wears off too soon

7. I have been diagnosed with Diabetes:

Yes

The pain you’re feeling can be hard to describe. This Pain Assessment Questionnaire has been designed to help you and your doctor to decide if the pain you’re feeling is nerve pain and if the cause is diabetes.

Talk to your doctor today and share your answers. Together, you can discuss options for managing your pain.

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