Pain Diary Template printable pdf download

Pain Diary Template

Pain

DiArY

How to use your pain diary

You may want to pull out this pain diary and photocopy it,

so you can use it more than once. Remember to photocopy

the back page as well.

1. Begin by noting down the date when you use a new diary.

You can fill in the diary as often as you need to. If your pain isn’t

well controlled, you may want to fill it in every 1–2 hours, but if it’s

better controlled, you can fill it in every 4–6 hours.

2. Note where the pain is on your body – you can use the body

pictures on the back page of the diary. It could be in one area

or in multiple areas.

3. Describe what the pain feels like. See the back page of the

diary for words you can use to describe your pain.

4. Rate the level of pain on a scale of 0 to 10, where 0 means no

pain and 10 means severe pain (see the back page of the diary).

5. Note down which medicines or pain control methods you used,

and anything that made the pain better or worse.

All of this information will help you and you healthcare team find

the best pain control methods for you.

Pain Diary Template