Pain Level	Description	Comments
10	Pain is:______________ How I feel:_____________ _______________________	What causes a "10":______________________ Percentage of day:______% What helps it:___________________________
8	Pain is:______________ How I feel:_____________ _______________________	What causes an "8":______________________ Percentage of day:______% What helps it:___________________________
6	Pain is:______________ How I feel:_____________ _______________________	What causes a "6":_______________________ Percentage of day:______% What helps it:___________________________
4	Pain is:______________ How I feel:_____________ _______________________	What causes a "4":_______________________ Percentage of day:______% What helps it:___________________________
2	Pain is:______________ How I feel:_____________ _______________________	What causes a "2":_______________________ Percentage of day:______% What helps it:___________________________
0	NO PAIN	Examples of when a "0" happens.____________ When and how often?_____________________ _______________________________________

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