Managing Cancer Pain
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Self-Care Cancer Pain Management Log
You can print out this log to keep a record of how well your medication is working to control your pain. Use the pain intensity scale to rate your pain before and after taking your medication. It is helpful to your doctor and nurse if you bring this along to your appointment or have it handy when you call the doctor about adjusting your pain medicines.
Please use this pain assessment scale to fill out your self-care log.
| 0 | 1 | 2 | 3 | 4 | 5 |
| No Pain | | | | | Worst Pain
Possible |
| Date | Time | Pain rating
(0-5) | Medicine I took | Intensity rating
one hour later | What I was
doing when
I felt the pain |
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