Pain Level Chart
You can describe your pain to the healthcare provider using any of the choices given below:
Type of pain (Tick as applicable)
Throbbing
Stabbing
Dull
Aching
Pinching
Steady
Localized
Pervasive
Chronic (persistent)
Acute (in the moment)
Other comments / Notes: ____________________________________________
Use the chart below to estimate your pain level.
Other comments / Notes:
(Include details on time when you felt the pain as well as activities that triggered the pain.)