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Pain Control Diary

Topic Overview

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 when you have pain, how bad it is, and what you are doing to treat it.

Pain scale shown by facial expressions

This figure has been reproduced with permission of the International Association for the Study of Pain® (IASP®). The figure may not be reproduced for any other purpose without permission.

These faces show how much something can hurt. The face on the left shows no pain. The other faces in turn show more and 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 you or a child hurts right now.

Pain control diary

Date

Time

Pain scale rating

Medicine and dose

Other pain relief methods

Side effects from pain medicine

         
         
         
         
         
         
         
         
         
         
Questions to ask my doctor
Notes

Credits

Current as ofMarch 28, 2019

Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Martin J. Gabica, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Michael S. Rabin, MD - Medical Oncology


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