Pain Control Record Chart
You can use a rating scale to describe:
Pain Intensity Scale (enter this number in the column "Pain scale rating.")
Use this form to record all medicines - not just pain medicines - you are now taking. This information will help your doctor keep track of all the medicines you are taking.
Medicines Taking Now Date:______________________________
Use this form to record the pain medicines you have taken in the past. It will help your doctor understand what has and what hasn't worked.
Pain Medicines Taken in the Past
For more, please visit the following MedicineNet.com areas:
The information above has been provided with the kind permission of the National Cancer Institute. For more information, you may also call the Cancer Information Service, at 1-800-4-CANCER (1-800-422-6237).
Last Editorial Review: 7/7/2004
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