Brief Pain Inventory Short Form - The University Of Texas Md Anderson Cancer Center Page 2
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1
2In addition to completing the Brief Pain Inventory,
Talking About Your Pain
to help your doctor better manage your pain,
It’s important to remember that each person’s pain
please tell us:
is different. The pain that you experience can’t be
compared to another person’s pain. ONLY YOU know
What does the pain feel like? Circle
how and when you hurt, and how the pain affects
those words that describe your pain.
your life.
aching
throbbing
shooting
It is important to describe what you are feeling to those
who are trained to help you. Don’t be embarrassed to
stabbing
gnawing
pricking
talk to your doctor, nurse, or pharmacist. They need to
know as much as possible about your pain in order to
sharp
tender
burning
develop the best plan to control it. The questions on
exhausting
tiring
penetrating
this form can help you describe your pain.
nagging
numb
miserable
Why Is Pain Relief So Important?
unbearable
dull
radiating
Proper treatment for pain is not only a matter of
squeezing
cramping
deep
comfort. Unrelieved pain can lead to nausea, loss of
sleep, depression, loss of appetite, weakness, and other
How long have you had this pain?
problems. Pain can also affect your life at home and at
(Circle one)
work. Relieving your pain means that you can continue
to do the day-to-day things that are important to you.
less than a week
1 to 2 weeks
Most Pain Can Be Controlled
2 to 4 weeks
more than a month
It is important to know that most pain CAN be relieved.
What kinds of things make your pain feel
Your doctor will work with you to find the treatment
better (for example, heat, medicine, rest)?
that may be best for your pain.
The key to effective pain control is to take the RIGHT
________________________________________________
AMOUNT, of the RIGHT MEDICINE, at the RIGHT TIME.
________________________________________________
You should take your pain medicine on a regular sched-
ule, as your doctor, nurse, or pharmacist tells you. Don’t
wait until the pain becomes severe. Pain is easier to con-
What kinds of things make your pain worse
trol when it is mild than when it has reached full force.
(for example, walking, standing, lifting)?
If your pain medicine wears off too soon, is not relieving
________________________________________________
the pain, or causes problems with side effects, you
should call your doctor because you may need to have
________________________________________________
your treatment plan changed.
Do you have any other symptoms?
Comments: Write down any questions or
Circle any that apply:
information you need to share with your
doctor, nurse, or pharmacist about your pain.
nausea
vomiting
constipation
diarrhea
_________________________________________________________
lack of appetite
indigestion
_________________________________________________________
difficulty sleeping
feeling drowsy
_________________________________________________________
nightmares
dizziness
_________________________________________________________
tiredness
itching
urinary problems
sweating
_________________________________________________________
weakness
headaches
_________________________________________________________
Provided as an educational service by
PM-0033R/September, 2004
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