Pain Diary - eMedicineHealth
Pain Diary - eMedicineHealth
Pain Diary - eMedicineHealth
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<strong>Pain</strong> <strong>Diary</strong><br />
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A pain diary may help you and your doctor find out what makes your pain better or worse. Use the diary below to keep track of<br />
when you have pain, how bad it is, and what you are doing to treat it.<br />
These faces show how much something can hurt. The face on the left shows no pain. The other faces in turn show more and<br />
more pain. The face on the right shows very much pain. You can use these faces to know what number to use to show how much<br />
you or a child hurts right now.<br />
Daily pain diary<br />
Date:<br />
Time:<br />
<strong>Pain</strong> scale rating:<br />
Medicine and dose:<br />
Medicine side<br />
effects:<br />
What made the pain<br />
better today<br />
What made the pain<br />
worse today<br />
Date:<br />
Time:<br />
<strong>Pain</strong> scale rating:<br />
Medicine and dose:<br />
Medicine side<br />
effects:<br />
What made the pain<br />
better today<br />
What made the pain<br />
worse today<br />
This figure has been reproduced with permission of the International Association for the Study of <strong>Pain</strong>® (IASP®).<br />
The figure may not be reproduced for any other purpose without permission.<br />
Daily pain diary<br />
© 1995-2013 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of<br />
Healthwise, Incorporated.<br />
This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this<br />
information.<br />
1
Date:<br />
Daily pain diary<br />
Time:<br />
<strong>Pain</strong> scale rating:<br />
Medicine and dose:<br />
Medicine side<br />
effects:<br />
What made the pain<br />
better today<br />
What made the pain<br />
worse today<br />
Daily pain diary<br />
Date:<br />
Time:<br />
<strong>Pain</strong> scale rating:<br />
Medicine and dose:<br />
Medicine side<br />
effects:<br />
What made the pain<br />
better today<br />
What made the pain<br />
worse today<br />
Daily pain diary<br />
Date:<br />
Time:<br />
<strong>Pain</strong> scale rating:<br />
Medicine and dose:<br />
Medicine side<br />
effects:<br />
What made the pain<br />
better today<br />
What made the pain<br />
worse today<br />
© 1995-2013 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of<br />
Healthwise, Incorporated.<br />
This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this<br />
information. 2
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