Pain Scale And Body Chart Template - Nhs

Pain Scale and Body Chart

1. Please use the scale below to tell us how intense your pain is. Place an ‘X’ through the

number that best describes the intensity of your pain now:

The most intense pain

No pain

sensation imaginable

2. Please use the body chart below to help us understand the pain areas

Please draw on the picture where you feel pain or any other sensations

(e.g. pins and needles).

Please describe below what the pain feels like (e.g. burning, tightness or

discomfort, sharp, ache), please use symbols below if this helps

Burning

Tightness or discomfort

Sharp

Ache

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Bradford Teaching Hospitals NHS Foundation Trust: Pain Rehabilitation Programme tool November 2010

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Parent category: Medical