Important Contact Information
- Oncologist: [Name] _____________________
- Phone: ________________________
- Primary Care Doctor: [Name] _____________________
- Phone: ________________________
- After-Hours Emergency Line: ________________________
- Emergency Services: 911
Pain Assessment Scale
0-10 Scale where:
- 0: No pain
- 1-3: Mild pain
- 4-6: Moderate pain
- 7-10: Severe pain
When to Take Action
Call Your Healthcare Team If:
- Pain is new or different
- Pain rating increases by 2 or more points
- Current pain medications aren't working
- You experience new side effects
- You have fever with pain
Seek Emergency Care If:
- Severe, sudden pain (8-10 on scale)
- Chest pain or difficulty breathing
- Severe headache with confusion
- Unable to move or severe weakness
- Loss of consciousness
Pain Medication Schedule
Regular Medications:
-
Name: ___________________
- Dose: _________________
- Schedule: _____________
-
Breakthrough Pain Medication:
- Name: ________________
- Maximum doses per day: _____
Pain Management Strategies
- Apply heat/cold as directed
- Use relaxation techniques
- Practice gentle movement
- Take medications as prescribed
- Track pain levels and triggers
Important Notes
- Keep this plan accessible
- Update contact information regularly
- Bring to all medical appointments
- Share with family members/caregivers
_Date Created: _______________
Next Review: _______________