The Pain Control Record Chart

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Pain Control Record

You can use a chart like this to rate your pain and to keep a record of how well the medicine is working. Write the information in the chart. Use the pain intensity scale to rate your pain before and after you take the medicine. Call your hospice nurse immediately if your pain increases or if you have new pain. Also call your nurse early for a refill of pain medicines. Do not let your medicines get below 3 or 4 days’ supply.


Please call your hospice team anytime for more information or support.


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