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Discuss the Impact of Your Pain

Pinpoint How Your Diabetic Nerve Pain Impacts Your Life

Many people with Diabetic Nerve Pain have a tough time with this. Maybe they don’t want to think about it. Maybe they already feel in over their heads with diabetes management. Whatever the reason, if you have pain, your doctor needs to know how it affects your life.

Why? Because treating your pain is an important part of overall diabetes care.

And remember, Diabetic Nerve Pain is a common problem. Approximately 26% of patients with diabetes also have Diabetic Nerve Pain. Your doctor will probably recognize it easily. But it is also important that your doctor understands how your pain impacts your daily life. This information will help open the door to a productive discussion of how to help you find ways to reduce your pain.

46% of Diabetic Nerve Pain sufferers ranked Diabetic Nerve Pain as their most bothersome diabetes complication. 85% ranked Diabetic Nerve Pain as at least one of their top 3 most bothersome complications.

Diabetic Nerve Pain Impact Questionnaire

How does your pain impact your life? Is it difficult to explain to your doctor? This Diabetic Nerve Pain Impact Questionnaire can help. It may be a step to help you move toward reducing your Diabetic Nerve Pain.

Answer these questions by clicking the appropriate answers. Then select Print. Take the form to your next appointment and share your answers with your doctor. You may also write down additional points you want to raise with your doctor.

 

I would describe the pain in my hands and feet as: (Check all that apply.)

 Burning

 Throbbing

 Painful tingling

Has your pain impacted your overall quality of life?

What daily activities does your Diabetic Nerve Pain impact? Check all that apply.

 Daily activities such as errands or housekeeping

 Spending time with my family

 Ability to exercise

 Ability to participate in hobbies I enjoy

 Ability to travel

 Ability to care for my family

 Ability to spend time with my friends

 Other

In what other ways does your Diabetic Nerve Pain impact your general quality of life? Check all that apply.

 The pain regularly has a negative impact on my mood.

 The pain decreases my general motivation.

 I avoid activities that cause my pain to flare up.

 The pain has had a negative impact on my interpersonal relationships.

 The pain has impacted my ability to make a living.

 Other

Does your pain keep you from falling asleep or getting a good night’s sleep?


On a scale of 0 to 10 with 0 being "My pain never bothers me while I’m falling asleep and/or wakes me up" and 10 being "I can hardly sleep at all," how would you rate the extent to which your pain affects your sleep?

 
0 1 2 3 4 5 6 7 8 9 10
 

Does your pain make it hard for you to do your job?


On a scale of 0 to 10 with 0 being "My pain never impacts my work" and 10 being "I am unable to work at all," how would you rate how your pain affects your work?

 
0 1 2 3 4 5 6 7 8 9 10
 

This site was created in collaboration with
Taking Control of Your Diabetes

The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a health care provider. All decisions regarding patient care must be made with a health care provider, considering the unique characteristics of the patient.