Pain Control Diary

The faces in the image show how much something can hurt. You can use these faces to help choose a number that shows how much you or your child hurts right now. The face on the left shows no pain. The other faces in turn show more and more pain. The face on the right shows the worst pain you have ever known. For example, if you have a "2" on the scale, your pain may be minor with stronger twinges now and then, but it doesn't impact your ability to do things. If you have an "8" on the scale, you may have very strong pain that makes it hard to do anything.

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 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