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My Pain Diary

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MY PAIN DIARY

DATE AND TIME DESCRIBE YOUR PAIN RATE WHAT MADE YOUR WHAT HELPED YOU DESCRIBE YOUR ACTIVITY COMMENTS
(e.g. how long it lasts, where it is, YOUR PAIN PAIN WORSE? GET THROUGH THE DAY? LEVEL AND MOOD (e.g. problems with medicines,
whether it moves, what it feels like (010, see (medicine and non-medicine (Has the pain affected your daily life, how your pain affects your daily life
dull, sharp, stabbing) overleaf) such as meditation, exercise etc) including sleep, work social life etc) sleep, mood, work etc.)
MY PAIN DIARY
What is a pain diary? When should I use a pain diary?
Use your pain diary as often as recommended by your doctor or pharmacist.
It helps you to describe to your healthcare team how your pain has been This may include when you have ongoing pain, changes in your activity levels
or changes in your medicines.
A pain diary also records how medicines, other therapies and your activities The information that you record will help you and your healthcare team prepare
and guide your pain management plan. If your pain is under control you may not
need to use the diary as often.
Why should I keep a pain diary? The more information you record in your pain diary, the more helpful it will be
A pain diary can help you and your healthcare team: for you and your healthcare team.

understand what makes your pain worse and what helps


to relieve your pain
How do I complete a pain diary?
Record all the information that is relevant to your pain in the diary over the page.
track your response to your pain management plan,
You may not need to fill out all columns each time.
including changes in your medicines or other therapies.
To complete the diary use the rating scale (below) to rate your activity. A zero (0)
means no pain and a ten (10) means worst possible pain. Select the number
that best describes your pain.

No pain Worst possible pain

0 1 2 3 4 5 6 7 8 9 10

This leaflet may be printed for patient use. June 2015

www.nps.org.au Level 7/418A Elizabeth Street Surry Hills NSW 2010 Independent, not-for-profit and evidence based, NPS enables better decisions about medicines
PO Box 1147 Strawberry Hills NSW 2012 and medical tests. We are funded by the Australian Government Department of Health and Ageing.
02 8217 8700 02 92 1 1 7578 info@nps.org.au National Prescribing Service Limited ABN 61 082 034 393

2013 National Prescribing Service Limited. This information is intended for health professionals. Reasonable care is taken to ensure that this information is accurate
at the date of creation. Health professionals must rely on their own expertise and inquiries taking into account the individual circumstances of each patient
when providing medical advice or treatment. Where permitted by law, NPS disclaims all liability (including for negligence) for any loss, damage or injury
resulting from reliance on or use of this information. NPSE0992a

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