Chronic Pain Patient Reporting Form

To the Patient:

      In my personal experience the classic 1-10 pain scale falls far short of the mark when it comes to reporting pain.  Chronic pain is as differing and variable as the number of people experiencing it.  No two people feel pain or express their experience of pain alike.  Because of this, reporting or talking about one's pain to another in a way that can be easily understood is a major and frustrating challenge for patient, family, employer, friends, and healthcare providers alike.
      Here I have devised a scale that can be revised as the pain patient's situation changes over time and will describe the quality and intensity of one's pain in terms anyone can, hopefully, agree upon and understand.
      The Randall Chronic Pain Scale allows patients to express pain measurement in a way that is unique to their particular situation.  It allows patients to use terms that are meaningful to them and understandable to others.  It allows for precise description of the intensity of the pain, what it is relative to, when it occurs, what brings it on or relieves it, and how it affects the patient emotionally and physically, and how long it lasts.  As circumstances change (eg. surgery, change in or addition of medication or other treatment, and other factors), patients can easily revise their pain scales upward or downward as needed.

Personalizing your pain scale:

      When choosing a word that describes what the numbers mean to you, try to avoid the use of words with a heavy emotional component such as "suicidal"  Still, choose a single word which best describes the overall feeling of the specific pain level.  Don't be afraid to have a "10".  (Early on, I didn't allow myself to have "10's".  Now I realize that it is possible to have a "10" experience and not have it feel like the end of the world.)  Perhaps, for you, a "10" is when you need to go to the emergency room.  For me it means that the pain is "Excruciating" or "Unbearable" and I can't do anything other than attend to the pain.  At that point, anything else is impossible.
      Some descriptive words you can use might be "intolerable", "difficulty tolerating", "tolerable", "distressing", "uncomfortable", "mild", "painful but bearable" etc.  Use words that have meaning to you.
      Still under description, add a few words that tell how the pain at that level makes you feel or what you must or are able to be doing such as, "must do something about pain, having difficulty concentrating but still able to perform simple tasks, able to perform most tasks, unable to do anything, don't notice pain unless attention is called to it", or whatever best describes your ability or inability to function.
      Under comments briefly describe what brings on that particular level of pain.  Some examples are "sitting, walking, standing, weather changes, increased activity, driving, stress, carrying things, lifting, lying in bed"  -  whatever it is that causes your pain to reach the level you are describing.  Use a phrase which best tells what you are able or unable to do, not how you feel.  How you are feeling emotionally does affect your pain.  We all vary widely in whether or not we attend to our pain because of our particular emotional state at the moment.  How or whether we respond to our pain at a given level is not consistent or predictable.  Therefore, this part of the pain scale should reflect your general ability to function.
      Finally, tell what relieves your pain or helps you maintain (taking meds, stretching, lying down, stopping activity, exercise, etc.)  You may want to assign a percentage or a time of day to a level if that is a common state for you.
      When I created my own pain scale and showed it to my doctors, we were all delighted to discover that they can now understand what I had not been able to explain to them before.  Because of this simple but effective change in communication, they are now able to help me manage my pain better than ever before.

To my Healthcare Provider:

      This is a chronic pain scale designed to help us communicate better.  I would like a few minutes of your time to go over it with you to help you better understand what I am trying to say when I describe my pain level to you.  Hopefully, with the help of this form, we can work together towards better pain management.

      * The Randall Personalized Chronic Pain Scale was created by Lois Randall.  No part of this scale may be reproduced or used without permission from the author at  Copyright © 1995-2010. Lois Randall. All Rights Reserved.