Pain Management Nursing Assessment Sheet
Patient Information
Name
Date of Birth
Medical Record No.
Pain Assessment
Onset
Duration
Frequency
Location
Intensity (0-10)
Quality (e.g., sharp, dull, throbbing)
Aggravating Factors
Relieving Factors
Associated Symptoms
Pain History
Previous Pain Episodes
Previous Treatments & Effectiveness
Pain Impact
Impact on Daily Living
Emotional Response
Current Pain Management
Medications
Non-pharmacological Interventions
Additional Notes