Pain Self-Assessment
A safety check, then the history a pain physician takes at a first visit, for pain anywhere in the body. You see the pattern your answers fit, whether the pain looks like it comes from the tissues, a nerve, or a sensitized pain system, and a one-page summary for any doctor. By Dr. Alex Movshis, MD. About 6 to 10 minutes.
Already know it is nerve pain? The Peripheral Nerve Entrapment Self-Assessment and the Post-Surgical Nerve Pain Self-Assessment go into more detail on a single nerve. This assessment runs the same logic when your answers call for it.
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What the assessment asks, in order
- Emergency check (9 yes-or-no items). The warning signs that need the nearest emergency room or 911 today: loss of bladder or bowel control, saddle numbness, progressive weakness or a new foot drop, fever with severe spinal pain, a stiff neck or a hot joint, a thunderclap headache, stroke signs, chest pain with breathlessness or sweating, inability to bear weight after a fall, and a swollen painful calf. Any "yes" stops the assessment.
- Where it hurts, and which side. Thirty-six named areas from the scalp to the feet, grouped by region, plus "many places at once" and "somewhere else", with left, right, both, or midline and a free-text description.
- About you, and warning signs for the areas marked. Age, past cancer, unexplained weight loss, fracture risk, headache warning signs, whether chest pain has had a heart and lung check, bowel and pelvic warning signs, and a hot swollen joint. These do not stop the assessment. They put a doctor's check ahead of any pain workup, and the result says which doctor and how soon, item by item (Finucane 2020; SNNOOP10, Do 2019).
- Onset and course. Sudden or gradual, what came before it, how long it has been there, and whether it is improving, worsening, or unchanged.
- After surgery (only if the pain began after abdominal, pelvic, or breast surgery). Post-operative warning signs first, then the questions of Modal Pain's post-surgical nerve pain assessment, asked word for word so its logic runs unchanged.
- What it feels like and how bad it is. Aching, sharp, throbbing, stiff, burning, electric, tingling, numb, and more, including the seven classic nerve-pain words. Average pain, worst pain, and how much it interferes with daily life, each 0 to 10.
- Timing, what changes it, and whether it travels. Constant or intermittent, morning stiffness, night pain; what makes it worse or better; whether it runs down an arm or leg, and any numbness or weakness.
- Questions for the area. Only the ones that apply to the areas you marked, described below.
- A tender-point self-check, where a trapped nerve or tendon has a known landmark.
- What has been checked and tried. Tests, treatments, and whether anything helped. Current pain medicines, blood thinners, diabetes, and procedure-related allergies, which a doctor needs before recommending an injection.
- Sleep, energy, and mood. Sensitivity to noise and light, broken sleep, fatigue, and the PHQ-2 and GAD-2 mood screens (Kroenke 2003; Kroenke 2007), which print for your doctor and can be skipped.
- Your main question. What is causing this, is it a nerve, why has nobody figured it out, what might help, do I need a scan, is it permanent, will I need surgery.
The published criteria behind each branch
- Headache. Migraine and tension-type features, attack length, headache days a month, and painkiller days against the International Classification of Headache Disorders (ICHD-3). Headache on 15 or more days a month with migraine features points to the chronic migraine Botox eligibility check.
- Face and jaw. Brief electric attacks set off by light touch, chewing, or talking, against jaw-joint features such as clicking and pain on chewing.
- Neck. Pain that travels down the arm, and an involuntary pull, turn, or tremor of the head, the features of cervical dystonia (Albanese 2013).
- Back. Leg pain past the knee with numbness or weakness (a nerve-root pattern), and the five ASAS items for inflammatory back pain: onset before 40, gradual onset, better with exercise, not better with rest, and night pain that eases on getting up (Sieper 2009).
- Joints and shoulder. The NICE clinical definition of osteoarthritis (age 45 or over, pain with use, morning stiffness of 30 minutes or less), the early-arthritis referral signs (swelling in several joints, knuckle involvement, long morning stiffness; Emery 2002), and shoulder features that separate a stiff joint from tendon pain.
- Belly. A self-performed Carnett's test: pain that stays the same or gets worse when you tense your stomach muscles points to the abdominal wall rather than the organs (Srinivasan 2002; Koop 2016).
- Pelvic floor. The history items of the Nantes criteria for pudendal neuralgia, after bowel, bladder, and gynecologic warning signs are cleared (Labat 2008).
- An arm or leg after injury or surgery. The four symptom groups of the Budapest criteria for complex regional pain syndrome (Harden 2010). The criteria also require exam signs, so this flags a pattern to check, and soon.
- Pain in many places. The widespread pain index and symptom severity scale of the 2016 fibromyalgia criteria (Wolfe 2016), reported as data for your doctor, since the self-report version is not valid for an individual diagnosis.
- Burning or numb feet. A symmetric pattern that starts in both feet, the usual shape of a polyneuropathy, with the standard screening blood tests named for your doctor (England 2009).
- A defined patch of nerve pain. The logic of the Peripheral Nerve Entrapment Self-Assessment: occipital, cluneal, lateral femoral cutaneous, suprascapular, superficial radial, intercostal, dorsal rami, sciatic, and pudendal patterns.
The three pain types it reports
The International Association for the Study of Pain describes pain by where it comes from. Nociceptive pain comes from tissue that is injured, inflamed, or overloaded. Neuropathic pain comes from a nerve that is injured or compressed. Nociplastic pain, the third type, comes from changes in how the nervous system processes pain, without enough tissue or nerve damage to explain it (Kosek 2016; Fitzcharles 2021). Many people have more than one. The assessment shows which types your answers carry features of and which answers put them there. The formal grading systems for neuropathic and nociplastic pain both include exam findings, so a history can point to a type but cannot grade it (Finnerup 2016; Kosek 2021). For what nociplastic pain and central sensitization are, and the evidence that sensitization can reverse when its source is treated, see central sensitization: why pain spreads, and when it goes away. For how these relate to acute and chronic pain, see types of pain: acute, chronic, and nerve.
What the result will not do
It will not name a disease, rank diagnoses by probability, or recommend a specific treatment. The mood and sleep scores never change the result you see. They print on the summary for your doctor. When a warning sign applies, the result puts that check first and says so plainly, even if the rest of your answers fit a pain pattern.
Privacy
Your answers are held in your own browser and cleared after 24 hours. The tool has no form and no server endpoint, so nothing you select is sent to Modal Pain. Anonymous usage analytics (for example, that a result screen was reached, never what you selected) may be recorded where privacy rules permit, and are off entirely in regions where consent has not been collected.
Frequently asked questions about the pain self-assessment
Three things. First, whether anything you report needs an emergency room or a doctor's check before it is treated as a pain problem. Second, which published clinical pattern your answers fit — for example a nerve-root pattern down the leg, an inflammatory back pain pattern, a migraine pattern, or pain that has spread to many areas — along with the answers that put you there. Third, the type of pain the pattern points to: from the tissues (nociceptive), from a nerve (neuropathic), or from a sensitized pain system (nociplastic). It does not name a diagnosis. You also get a one-page summary of your answers to print or send to any doctor.
Nerve pain tends to burn, shock, tingle, or come with numbness, and it follows the path of one nerve: a strip down the leg, a band along one rib, a defined patch of skin. Muscle, joint, and tendon pain tends to ache or feel sore and stiff, changes with movement and load, and is tender where it hurts. Many people have both at once, which is called mixed pain. A questionnaire can show nerve features but cannot confirm nerve pain on its own. That takes an exam of sensation, strength, and reflexes, and sometimes a nerve conduction study or a diagnostic nerve block (Finnerup 2016).
They are the three mechanistic pain types defined by the International Association for the Study of Pain. Nociceptive pain comes from tissue that is injured, inflamed, or overloaded, such as a joint, tendon, disc, or muscle. Neuropathic pain comes from a nerve that is injured or compressed. Nociplastic pain, the third type, added in 2017, comes from changes in how the nervous system processes pain signals, without enough tissue or nerve damage to explain it. Fibromyalgia is the best-known example (Kosek 2016; Fitzcharles 2021). Each type is treated differently, which is why the assessment reports it.
No. It applies published clinical criteria to what you report, and every diagnosis still takes a doctor's exam and judgment, and sometimes tests. Several of the criteria it uses say so in their own text: the widespread pain survey is not valid for an individual diagnosis when self-reported (Wolfe 2016), and the criteria for complex regional pain syndrome require signs a clinician sees on examination (Harden 2010). The result tells you where the exam should start.
Long-lasting pain, sleep, and mood affect each other, and pain physicians ask about all three at a first visit. The four mood questions are the PHQ-2 and GAD-2, two standard brief screens. Your scores print on the summary for your doctor, who reads them together with everything else. They do not change the result you see, and you can skip them. If you are having thoughts of harming yourself, call or text 988, or call 911.
Go to the nearest emergency room or call 911 for pain with new trouble controlling your bladder or bowels, new numbness in the groin or inner thighs, an arm or leg getting weaker over hours or days, fever with severe back or neck pain or a stiff neck, a sudden worst-ever headache, stroke signs, chest pain with shortness of breath or sweating, being unable to stand after a fall, or a swollen, painful calf. The assessment asks about each of these first and stops if any applies.
Yes. If your pain started after abdominal, pelvic, or breast surgery, the assessment asks the same questions as Modal Pain's post-surgical nerve pain assessment and runs the same logic, so you do not have to start over. It also asks about warning signs after a recent operation, such as a red, hot, or draining wound, a fever, or severe belly pain with vomiting, which need the surgical team or an emergency room first.
They stay in your own browser and are cleared after 24 hours. The tool has no form and no server, so nothing you select is sent to Modal Pain. The summary is built in the same browser, and printing, saving, or copying it sends nothing anywhere.
Most major commercial PPO plans cover a pain evaluation and the procedures that follow from it, often with prior authorization. Modal Pain Management verifies your benefits before the first visit. We work with most major commercial PPO plans and do not participate with Medicare or Medicaid. If your insurance is Medicare-primary, the printed summary is still useful to bring to your existing doctors.
What happens after the assessment
Bring the printed summary to your visit, here or with any doctor. It is laid out the way a physician reads a history, so the visit starts from your answers instead of from the beginning. At Modal Pain Management, 369 Lexington Avenue, Floor 25, in Midtown Manhattan, the first visit is a focused exam of the area your answers point to, with in-office ultrasound and, when the exam supports it, a same-day diagnostic injection. Same-week new-patient visits are routinely available.
Modal Pain Management does not accept Medicare. We work with most commercial PPO insurance plans, and the office team verifies your coverage before scheduling. If your insurance is Medicare-primary, the summary is still useful to bring to your existing care team.
Book a consultation, verify your insurance, or read about Dr. Movshis.