Zero Mild Moderate Severe somewhat interfere Extreme interfere with completely activity

Mild Moderate Severe Extreme

Burning Electric like Knife like Contracting I cant describe

Numbness / Paresthesia Weak sensation Cold / Heat Lost sensation on Weak muscle Muscle atrophy Swelling pain site Increase sweating at pain site

No Little Sometimes Most nights Always

Zero Little Moderate Severe Extreme

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

No Little Moderate Severe Extreme

No Little Moderate Severe Extreme

0 1 2 3 4 6 7

0 1 2 3 4 5 6 7

0 1 2 3 4 5 6 7

No Yes

Sitting Standing Walking Stair use Changing side on bed Scratching your midback with your thumb Putting your forearm against back of neck Making Fist Open and close cans cover Moving your head to the sides Lying on your side Extreme

No Little Moderate Severe Severe

No Yes, but I can depend on myself Yes, I can’t depend totally on my self, I need some assistance Yes, I’m completely dependant on others

No Yes, what is the name of medicine?

No Yes, please upload it.

No Yes, please upload it.