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Pain Scale Assessment

Use our pain scale assessment to help identify possible solutions to help improve your quality of life.

Pain Scale Assessment

Step 1 of 3

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OBTAIN MORE INSIGHT AND GAIN A FRESH PERSPECTIVE OF YOUR CONDITION.
Use our pain scale assessment to help identify possible solutions to help improve your quality of life.
We encourage you to discuss the results of this assessment with your medical doctor.
Your Name:*
Your surname:*
Your email address*

In what area do you currently reside?*
- Gauteng
- Limpopo
- North West
- Mpumalanga
- Kwazulu-Natal
- Free-State
- Eastern Cape
- Northern Cape
- Western Cape
- Namibia

I have pain in the following regions
Neck*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Hidden
Neck > 0
Shoulders*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Hidden
Shoulders > 0
Hands*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Hidden
Hands > 0
Lower Back*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Hidden
Lower Back > 0
Hips*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Hidden
Hips > 0
Knees*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Hidden
Knees > 0
Feet*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Hidden
Feet > 0
Hidden
Sometimes
Hidden
Often
Hidden
Very Often
6 I take / use / need the following medication
Painkillers*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Anti-inflammatories*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Herbal & natural agents / supplements*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Hidden
Q6 Natural = 0-1
Hidden
Q6 Natural = 2-4
7 I experience pain...
When Walking*
- Never
- Rarely
- Sometimes
- Often
- Very Often
When climbing stairs*
- Never
- Rarely
- Sometimes
- Often
- Very Often
At night time*
- Never
- Rarely
- Sometimes
- Often
- Very Often
During rest*
- Never
- Rarely
- Sometimes
- Often
- Very Often
With weight bearing*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Hidden
Q7 - Walking, Climbing Stairs
and is exacerbated during activities like walking and climbing stairs
Hidden
Q7 - Walking
and is exacerbated during activities like walking
Hidden
Q7 - Climbing Stairs
and is exacerbated during activities like climbing stairs
Hidden
Q7 - night during rest
and also occurs at night time, during rest
Hidden
Q7 - night
and also occurs at night time
Hidden
Q7 - rest
and also occurs during rest
Hidden
Q7 = Weight Bearing
or simply when weight bearing
8 I experience stiffness...
In the morning*
- Never
- Rarely
- Sometimes
- Often
- Very Often
Later in the day*
- Never
- Rarely
- Sometimes
- Often
- Very Often
9 I experience difficulty
When climbing down stairs (descending)*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
When climbing up stairs (ascending)*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Rising from sitting*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Standing*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Bending over to the floor*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Walking on a flat surface*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Getting in/out of a vehicle*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Going shopping*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Putting on my socks*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Lying in bed*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Taking off my socks*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Getting out of bed*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Getting in/out of a bath*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Sitting*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Getting on/off the toilet*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Doing light domestic duties*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Doing heavy domestic duties*
- No difficulty
- Slight difficulty
- Moderate difficulty
- Great difficulty
- Extreme difficulty
Which of the following best describes your current weight status?*
- Underweight
- Normal weight
- Slightly overweight
- Moderately overweight
- Severely overweight
Hidden
Q9 Total
Hidden
Q9 = 0
Hidden
Q9 = 1-9
Hidden
Q9 > 9
Hidden
Q10 Total
Hidden
Q10 = 0
underweight
Hidden
Q10 = 1
normal weight
Hidden
Q10 = 2
slightly overweight
Hidden
Q10 = 3
moderately overweight
Hidden
Q10 = 4
severely overweight
Hidden
Q10 >= 2
While the thought of losing a large amount of weight may be daunting, it may encourage you to know that a loss of 5kg has been shown to decrease knee pain by an impressive 50%. You can download a complimentary copy of our insulin-friendly meal plan (C.A.P.E meal plan) from our website. It is a healthy balanced diet, specifically formulated to assist with weight loss. Insulin resistance is a major contributing factor towards weight gain. A waist circumference of more than 80 cm in females and more than 94 cm in males is a sign that insulin resistance may be present. If that is the case, we recommend our product called AntaGolin in combination with exercise and the CAPE meal plan.
Which one of the following options best describes your current stress level?*
- Not stressed at all
- Slight stressed
- Moderate stressed
- Severely stressed
Hidden
Q11 = Moderately & Q7 > 1
You indicated that you are moderately stressed and that you experience severe pain at night which may interfere with a good night’s sleep and which naturally contributes to increased stress. Exercise not only plays a role in diminishing pain and in maintaining joint mobility; it also helps with stress management. Stress may lead to tension headaches and can also decrease one’s tolerance towards pain and discomfort. NeuroVance, is a brain supplement that optimises brain function and so helps with day-to-day stress, increased work load and difficulty in concentrating. Another suggestion is to incorporate SleepVance, formulated to target different pathways involved in sleep quality and quantity, including optimising hormones, neurotransmitters and nutrients involved in regulating the sleep cycle.
Hidden
Q11 = Severly & Q7 > 1
You indicated that you are severely stressed and that you experience severe pain at night which may interfere with a good night’s sleep and which naturally contributes to increased stress. Exercise not only plays a role in diminishing pain and in maintaining joint mobility; it also helps with stress management. Stress may lead to tension headaches and can also decrease one’s tolerance towards pain and discomfort. NeuroVance, is a brain supplement that optimises brain function and so helps with day-to-day stress, increased work load and difficulty in concentrating. Another suggestion is to incorporate SleepVance, formulated to target different pathways involved in sleep quality and quantity, including optimising hormones, neurotransmitters and nutrients involved in regulating the sleep cycle.
Hidden
Q11 Moderately & Q7 < 2
You indicated that you are moderately stressed which may interfere with a good night’s sleep and which naturally contributes to increased stress. Exercise not only plays a role in diminishing pain and in maintaining joint mobility; it also helps with stress management. Stress may lead to tension headaches and can also decrease one’s tolerance towards pain and discomfort. NeuroVance, is a brain supplement that optimises brain function and so helps with day-to-day stress, increased work load and difficulty in concentrating. Another suggestion is to incorporate SleepVance, formulated to target different pathways involved in sleep quality and quantity, including optimising hormones, neurotransmitters and nutrients involved in regulating the sleep cycle.
Hidden
Q11 severely & Q7 < 2
You indicated that you are severely stressed which may interfere with a good night’s sleep and which naturally contributes to increased stress. Exercise not only plays a role in diminishing pain and in maintaining joint mobility; it also helps with stress management. Stress may lead to tension headaches and can also decrease one’s tolerance towards pain and discomfort. NeuroVance, is a brain supplement that optimises brain function and so helps with day-to-day stress, increased work load and difficulty in concentrating. Another suggestion is to incorporate SleepVance, formulated to target different pathways involved in sleep quality and quantity, including optimising hormones, neurotransmitters and nutrients involved in regulating the sleep cycle.
Hidden
Q11 < 2 & Q7 > 2
You indicated that your stress levels are very low, but that you experience severe pain at night which may interfere with a good night’s sleep.
Hidden
Q11 < 2 & Q7 < 2
You indicated that your stress levels are very low.