The Pain Snapshot

A clearer way to tell your care team how pain is affecting your life. Fill it out before your appointment and hand it to your provider — so a single number from 0 to 10 never has to speak for everything you live with.

Download & print the Pain Snapshot (PDF)

What's on the sheet

Five quick steps, then one sentence you can read aloud to your provider.

1 — How much is pain limiting you today?

A 0–10 scale in plain words, so your number actually means something:

0No pain.

1–2Mild. It's there, but I can ignore it. It doesn't stop me from anything.

3–4Nagging. I notice it constantly. I can still do most things, just slower or with breaks.

5–6Disruptive. It interrupts me. I have to change, pause, or drop activities.

7–8Severe. It runs my day. I can't do most normal activities or focus on much besides the pain.

9Crushing. I can't function. I can barely move or talk. All I can do is get through it.

10Emergency. Unbearable. I need help now.

2 — Your baseline vs. today

What your pain is on a normal day, right next to what it is today — because “fine” for you may not be fine at all.

3 — What pain is stopping you from

Sleeping, standing or walking, bathing or dressing, work or chores, concentrating, mood, being present with family.

4 — What your pain feels like

Burning, stabbing, throbbing, electric or shooting, crushing, aching, cramping, tearing, pins & needles — the words that tell a provider the kind of pain, not just the amount.

5 — Since your last visit

Better, about the same, or worse — plus your worst and best moments, so they see the whole picture.

Then, say it in one sentence. Fill in the blanks and read it aloud: “On a normal day my pain is a ____, but today it is a ____. It is stopping me from ____. It feels ____, and since my last visit it has gotten ____.”

This is a communication tool to help you describe your pain. It is built from established pain-assessment methods, but it is not itself a clinically validated instrument, and it does not replace your provider's evaluation, diagnosis, or advice.

Download & print the Pain Snapshot (PDF) Join the movement