Cancer Pain Management Plan

Patient Information

Name: _________________________ Date: _________________________ Oncologist: ____________________

Pain Assessment

Pain Scale

• 0: No pain
• 1-3: Mild pain
• 4-6: Moderate pain
• 7-10: Severe pain

Current pain level: ____/10

Pain Characteristics

• Location: _____________________
• Type: □ Sharp □ Dull □ Burning □ Throbbing
• Timing: □ Constant □ Intermittent

Treatment Plan

Medications

1. Primary Pain Medicine

   • Name: ______________________
   • Dose: ______________________
   • Frequency: _________________

2. Breakthrough Pain Medicine

   • Name: ______________________
   • Dose: ______________________
   • When to use: _______________

Non-Medication Approaches

• □ Heat therapy
• □ Cold therapy
• □ Relaxation techniques
• □ Physical therapy
• □ Massage

Monitoring Plan

Daily Pain Diary

• Record pain levels 3 times daily
• Note medication effectiveness
• Document side effects

Red Flags (Call Healthcare Team)

• Pain not controlled by prescribed medications
• New or worsening symptoms
• Severe side effects
• Fever above 101.5°F

Emergency Contacts

Oncology Clinic: ________________ After Hours: ___________________ Emergency: 911

Follow-up Plan

Next appointment: _______________ Pain specialist referral: □ Yes □ No