Apr 08 2009

Evaluating Chronic and Acute Pain Interview

If you are experiencing pain, here is an evaluation form to help you begin to better understand the complex issues.

Here is the evaluation:

Pain Interview

How can we be helpful? (Presenting Concerns)

Describe what your pain feels like and where you experience it in your body. Does it travel? Is it on the surface of your skin or deeper? (Pain Experience)

When did this pain begin and how do you think it was caused? (Onset)

If you could paint a picture/photograph of your pain when it is bad, what would it look like? (Imagery)

What seems to help your pain feel better/bring relief? If you could take a photograph of what brings you relief, what would it look like?  What seems to block you from having the pain relief you want? (Relief factors/Imagery)

What activities, time of the day, situations make the pain get worse? (Triggers)

How bad is your pain right now using a 0-10 scale where 10=worst pain imaginable? How does it interfere with your life? What changes, losses have it created? (Severity)

What does your support system look like? How has it changed? (Support)

What are you most afraid of now?
What was the most anxious, fearful experience of your life?
When were you the most sad or depressed?
When were you the happiest?
When were you the most proud?

Has anything like this ever happened before to you? Have you been mistreated, physically, emotionally or sexually abused as a child, teenager or adult?
(Past Vulnerability)

Who else have you asked for help with this pain? How helpful was this help on a scale of 0-100% (Previous Treatment)

Is there anything you stand to gain or have already gained as a result of this accident/pain/injury?  (Secondary gain)

(Pain Imagery)
What does your pain look like when you imagine it at its…


Imagine what brings you pain relief. What does it look like?

(Miracle Imagery)

Imagine yourself pain free.

What do you look like?

How do you feel?

What are you doing?

Who are you with?

How has your life changed?

On a scale of 0-100%, how motivated are you to do everything you can to get relief from your pain?  (Motivation)

How much have you improved since starting therapy (0-100%)? (Improvement)

What else do you think I should know at this time?  (Additional Info)

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