PATIENT INFORMATION QUESTIONNAIRE
Select one or more items below to describe the nature of your pain: Throbbing Shooting Sharp Cramping Hot/burning Aching Stabbing. How do the following factors affect your pain? (check one blank per number) Better Worse No effect Better Worse No effect. 1. Heat 6. Climate 2. Cold 7. Fatigue 3. Lying down 8. Coughing 4. ................
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