Evaluating Back Pain Neck Pain Denver, Colorado

Swedish Medical Center

501 E. Hampden Avenue
Englewood, CO 80113

(*) denotes required information.
Pain Intensity
I can tolerate the pain I have without pain killers - 0 pt The pain is bad but I usually manage it without taking pain killers - 1 pt Pain killers give me complete relief from pain - 2 pts Pain killers give me moderate/some pain relief - 3 pts Pain killers provide me very little relief from pain - 4 pts Pain killers don't address the pain so I don't use them - 5 pts
Personal Care
I would not have to change my way of washing or dressing in order to avoid pain - 0 pt I don't normally change my way of washing/dressing though it causes me some pain - 1 pt Washing and dressing increase the pain but I manage to not change my way of doing it - 2 pts Washing and dressing increase the pain; it's necessary to change my way of doing it - 3 pts Because of the pain I am unable to do some washing and dressing without help - 4 pts Because of the pain I am unable to do any washing or dressing without help - 5 pts
Lifting
I can lift heavy weights without extra pain - 0 pt I can lift heavy weights but it gives me extra pain - 1 pt Pain prevents me from lifting heavy weights off the floor but I can manage if they are positioned on a table - 2 pts Pain prevents me from lifting heavy weights but I can manage to lift lighter weights if they are conveniently positioned - 3 pts I can only lift very light weights at most - 4 pts I cannot lift or carry anything at all - 5 pts
Walking
Pain does not prevent me from walking - 0 pt Pain prevents me from walking more than one mile - 1 pt Pain prevents me from walking more than a 1/2 mile - 2 pts Pain prevents me from walking more than a 1/4 mile - 3 pts I can only walk using a stick or crutches - 4 pts I am sedentary most of the time and cannot walk - 5 pts
Sitting
I can sit in any chair as long as I like - 0 pt I can only sit in my favorite chair as long as I like - 1 pt Pain prevents me from sitting for more than 1 hour - 2 pts Pain prevents me from sitting more than 30 minutes - 3 pts Pain prevents me from sitting more than 10 minutes - 4 pts I avoid sitting because I experience pain immediately - 5 pts
Standing
I can stand as long as I want without pain - 0 pt I can stand as long as I want but it gives me extra pain - 1 pt Pain prevents me from standing for more than 1 hour - 2 pts Pain prevents me from standing for more than 30 minutes - 3 pts Pain prevents me from standing for more than 10 minutes - 4 pts I avoid standing because of the pain- 5 pts
Sleeping
I do not have any pain while in bed - 0 pt Pain does not prevent me from sleeping or I can sleep well with sleeping pills - 1 pt Even when I take sleeping pills I get less than 6 hours of sleep because of the pain - 2 pts Even when I take sleeping pills I get less than 4 hours of sleep because of the pain - 3 pts Even when I take sleeping pills I get less than 2 hours of sleep because of the pain - 4 pts Pain prevents me from sleeping at all - 5 pts
Social Life
My social life is normal and gives me no pain - 0 pt My social life is normal but it incrases the degree of pain - 1 pt Pain doesn't specifically affect my social life except the more energetic interests such as dancing - 2 pts Pain has restricted my social life and I do not go out very often - 3 pts Pain has restricted my social life to my home - 4 pts I hardly have any social life because of the pain - 5 pts
Traveling
I get no pain when traveling - 0 pt I can travel anywhere but it gives me extra pain - 1 pt Pain is bad but I manage journeys more than 2 hours - 2 pts Pain restricts me to journeys of less than 1 hour - 3 pts Pain restricts me to short necessary journeys under 30 minutes - 4 pts Pain prevents me from traveling except to the doctor or hospital - 5 pts
Your Degrees of Pain
My pain is rapidly getting better - 0 pt My pain fluctuates but is definitely getting better - 1 pt My pain seems to be getting better but improvement is slow - 2 pts My pain is the same - neither better nor worse - 3 pts My pain is gradually getting worse - 4 pts My pain is quickly getting worse - 5 pts
If you would like someone from Swedish to contact you about your back pain or our spine services, please provide your information below. By completing and sending this information, you are giving your permission for personal health information to be sent to the Spine Nurse Care Coordinator.
* Full Name:
* Email:
* Phone:
Questions

Back Pain Quiz

Take this brief quiz (10 questions) to help you determine the severity of your back pain and when to seek treatment from Denver's Swedish Medical Center spine experts.

Related Doctors