MannaLife - Pain Management Assessment

Question 1 of 8

Where do you experience the most pain? (Select all that apply)

Lower back

Neck and shoulders

Knees

Hips

Head (headaches/migraines)

Other joints or areas

Question 2 of 8

How would you rate your pain on average?

No Pain

Severe Pain

Question 3 of 8

How long have you been dealing with this pain?

Less than 3 months

3-6 months

6-12 months

1-3 years

More than 3 years

Question 4 of 8

Which movements or activities do you avoid because of pain?

Bending or lifting

Sitting for extended periods

Standing or walking

Exercise or sports

Certain sleeping positions

Daily activities (cleaning, cooking, etc.)

Question 5 of 8

How often do you use pain medication?

Never - I avoid medications

Rarely - only when absolutely necessary

A few times per week

Daily

Multiple times daily

Question 6 of 8

How often do you practice breathwork or relaxation techniques?

Never heard of using them for pain

Tried them but didn't help

Occasionally when pain is bad

Several times per week

Daily practice

Question 7 of 8

How much does pain affect your daily life?

Minimal impact - I can do most things

Some limitations but manageable

Significant impact on work and activities

Major limitations - affects most aspects of life

Debilitating - controls my entire life

Question 8 of 8

What's your primary pain management goal?

Just reduce the pain enough to function

Get back to normal daily activities

Return to exercise and active lifestyle

Achieve complete pain freedom and peak performance

Pain Management Assessment