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Pain Meter | Lumov

Email ID?

*

1. Where is your pain located?

*

1. Where is your pain located?

A

Lower back

B

Foot & Ankle

C

Elbow & Wrist

D

Knee

2. How did the pain originate?

*

2. How did the pain originate?

A

Gradual onset

B

Injury / Accident

C

Post-operation

D

Do not know

3. How would you describe the intensity of your pain?

*

3. How would you describe the intensity of your pain?

0

1

2

3

4

5

6

7

8

9

10

Mild Moderate Unbearable

4. How does the pain impact your daily activities?

*

4. How does the pain impact your daily activities?

A

Difficulty walking or standing for long periods

B

Difficulty sitting for long periods

C

Difficulty sleeping due to pain

D

Difficulty performing work-related tasks

E

Difficulty with self-care (e.g., dressing, bathing)

F

Difficulty exercising or participating in sports

5. What does your pain feel like?

*

5. What does your pain feel like?

A

Dull ache

B

Sharp

C

Throbbing

D

Burning

E

Tingling

6. How long have you been experiencing this pain?

*

6. How long have you been experiencing this pain?

Less than a week

Week to month

More than 3 months