This is an example of a Personal Pain Report

 

TMT Personal Pain Report

Name: Backus Sciatica
Email Address: backnsciatica@hotmail.com
Mailing Address:
177 East 75th Street, New York, NY 10021.
Age: 37.
Gender: Male.

Pain Drawing (Black outline = pain area. Red spot = worst pain within an area):

 


Location of Most Troublesome Chronic Pain: Buttocks or back/outside of Thigh.
Other Chronic Pain Locations: Lower back.

Average Severity of Most Troublesome Pain (0=None, 10=As bad as you can imagine): 5.
Duration Most Troublesome Pain: 6 months.
Characteristics of Most Troublesome Pain: Painful area feels hot/burning. Painful area feels like pins and needles. Painful area feels numb. Pain is like an electric shock. Painful area feels tingling.
Chronic Pain in Sciatica Area: L5 nerve root.


Click THIS LINK to view a list of pain articles available to the public that are selected for you according to the location and type of your own pain.


Date of Report: February 4, 2005.
This report was prepared by TMT Inc.,
New York, NY, USA (www.masterdocs.com).

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