Patients on their deathbeds should be given more pain relievers even if the drugs hasten death, researchers at a Toronto-based medical ethics think-tank argue in a study released in March 2003.

 When did your pain start? __________
2: What caused the pain?_______________
3: Have you had prior pain problems? (circle one) YES NO

A diary/log used to rate the effectiveness of the (or each of the) medications you may be using for your pain.

Use this form as another tool of communicating the level and area of your pain with your physician or health care provider.

Request a Refill

5 + 4 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.