Pain Management Doctors in New Jersey

Rate Your Pain

Range Slider

0

1

2

3

4

5

6

7

8

9

10

Mild Pain, Tolerable most of the time.

Moderate Pain, Untolerable sometimes.

Severe Pain, unbearable most of the time.

Excruciating Pain, Unable to complete tasks on a daily basis. Life impairing.

Radiating Arm Pain

Radiating arm pain through your arms or hands is a common symptom of a spine related problems.

Does Your Pain Radiate into Your Arms?

Because your pain is upper back/neck, choose an answer that best describes if pain radiates to your arms.

Does Your Pain Radiate into Your Arms?

Shoulder/Upper Arm

Down One Arm into Hand

Down Both Arms

No Radiating Arm Pain

Radiating Face Pain

Radiating face pain can be a symptom of a rare spinal condition.

Do You Experience Severe Jabbing or Radiating Pain to Your Face?

Yes

No

Pain Presents Itself in Different Ways

Describing your pain accurately can make it easier for your doctor to find the cause of your pain and recommend the right treatment. Please select all of the choices that help best describe your pain.

The Origins of Your Pain

Understanding the origins behind your pain is very important. When did you first notice the pain? Has the pain gotten worse over time?

Pain is normally caused by trauma or degeneration (wear and tear). For example, you can twist your knee playing tennis and feel immediate pain, or you can develop pain in your shoulder from playing tennis for 8 hours a day all summer. One pain is immediate and the other pain develops gradually over time.

The Length of Your Pain

Co-ordinating how long you have been in pain alongside the origin of the pain helps the doctor get a clear understanding of how your pain has progressed and how deeply rooted the pain is. Pain that has lasted for years has deep roots and can be approached differently then pain that has only been around for a few days or weeks.

How Long Have You Been in Pain?

From the choices below, do your best to select the one that best indicates how long you have been in pain for.

How Long Have You Been in Pain?

Days

Weeks

Months

Years

Daily Activities

Every pain is different and determining what movements or actions initiate the feeling of pain or make the pain feel worse helps the doctor better understand the cause and source of the pain.

What Makes Your Pain Worse?

From the choices below, select all of them that either initiate your pain or make your pain worse.

Daily Activities

Just as some activities or motions can be harmful, some of them can actually help alleviate your pain and make you more comfortable. This to is important for the doctor to help him better understand the starting point for your relief.

Taking Steps to Live Pain Free

Some people live with pain for years and never see a doctor. Some people get injured and are at the doctor the next day. It is important to share with the doctor all your previous treatments. Sharing this will help the doctor determine a starting point for your treatment moving forward.

What Treatments Have You Had?

Select all of the treatments listed below that you have already had in the past.

Associated Pain Symptoms

Sometimes there are other symptoms present with the onset of back or neck pain.

Determining what symptoms are associated with your pain helps the doctor identify the cause of your pain.

Do You Experience Any of the Following Symptoms Associated with Your Pain?

Muscle Tightness or Stiffness

Weakness in Hand/Arm/Foot or Leg

Uneven Hip or Shoulders

None

Previous Medical Image Testing

If you have already had some medical image testing done such as an XRAY, MRI or CT Scan, the doctor can use those tests to help in his diagnosis of your pain. Sometimes the test can be outdated however and the doctor may or may not require you to get new tests done.

Understanding More About You

The doctor benefits greatly from having a general outline of your personal stats. Age height and weight all play a significant role in helping to determine factors that may or may not be associated to your pain.

Please Enter Your Age

Your Pain Evaluation Is Being Reviewed

Thanks for taking the time to fill out the pain evaluation. Once submitted it will be reviewed and once the review is complete we will send you your results. The results will contain likely conditions and recommended next steps.

How Would You Prefer to Receive Your Results?

We can either text them to you or contact you directly by phone.

How Would You Prefer to Receive Your Results?

By Phone

By Text

You’re Almost Done!

Tell us where to reach you with your results, and our care team will contact you soon to review them and discuss next steps to help you feel better.

Name

Phone/Mobile

Email

Best Time to Contact You

By clicking next you are confirming you have read and agree to the Terms of Use of the pain evaluation.

Suffering from Pain?

Back and Neck Pain Treatment Evaluation

3 Easy Steps

Select a Problem Area

Suffering from Pain?

Back and Neck Pain Treatment Evaluation

3 Easy Steps

Select a Problem Area

Rate Your Pain

Rate Your Pain

Rate Your Pain

Rate Your Pain

Back and Neck Pain
Treatment Evaluation

Back and Neck Pain
Treatment Evaluation