Pain Disease Inquiry Need to Know Complaint: History: Trigger ( ), Onset ( ), Location ( ), Duration ( ) Wang Xinchun, Department of Rehabilitation and Pain, Qinghai Hospital of Traditional Chinese Medicine Nature: Sharp pain ( ) Distension ( ) Stabbing pain ( ) Throbbing pain ( ) Cold pain ( ) Scurrying pain ( ) Squeezing pain ( ) Drilling pain ( ) Spasmodic pain ( ) Radiating pain ( ) Cutting pain ( ) Dull pain ( ) Sour pain ( ) Strangulation pain ( ) Cramping pain ( ) Numbness pain ( ) Tearing pain ( ) Tearing pain ( ) Tension pain ( ) Pain ( ) Electric shock pain ( ) Heavy pain ( ) Pain ( ) Burning pain ( ) Strength: (none Mild, moderate, severe, severe, most ) Aggravating factors: Relieving factors: Accompanying symptoms: (none Mild, moderate, severe, most ) Nyeri ( )nyeri sengatan listrik ( )nyeri berat ( )nyeri yang melibatkan ( )nyeri terbakar ( ) Intensitas: (tidak ada Ringan Sedang Berat Dramatis Paling banyak) Faktor yang memberatkan: Faktor yang meringankan: Gejala yang menyertai: Pengobatan: Pengobatan saat ini: Kondisi Umum: Mental ( ) Diet ( ) Tidur ( ) Buang air besar ( ) Urin ( ) Usaha Fisik ( ) Berat badan ( ) Riwayat Kesehatan: Kesehatan ( ) Penyakit Menular ( ) Pembedahan ( ) Trauma ( ) Alergi ( ) Riwayat Kesehatan Lainnya ( ) Riwayat pribadi: lingkungan pekerjaan ( ) Kebiasaan hidup ( ) Riwayat tembakau dan alkohol ( ) Riwayat keluarga: