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Pain diary

This is an example of a simple pain diary. Note down how bad (or good!) your pain is each day, using a numeric scale:

0 = no pain
1-3 = occasional mild pain that I can put up with
4-5 = moderate pain that limits some activities
6-10 = severe pain, affecting activity and concentration a lot

Use the comments line to add notes on whether or not you took extra painkillers, or did any specific activity such as gardening. You could also use this section to note down any side effects that you may be experiencing from your current pain medication. 

  MonTuesWedThurFriSatSun
Pain levelMorning       
Evening       
Comments        

Download a pain diary (in PDF format) that you can print out and fill in. You will need Adobe Reader (opens in a new window) to view the pain diary PDF.

Pain checklist

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