daily pain diary day & date: pain/distress no pain/distress as bad as it could be 0 1 2 3 4 5 6 7 8 9 10 pain pain medicine time intensity distress activity comments or tablets 0-10 0-10 6.00am 7.00am 8.00am 9.00am 10.00am 11.00am 12.00 1.00pm 2.00pm 3.00pm 4.00pm 5.00pm 6.00pm 7.00pm 8.00pm 9.00pm 10.00pm 11.00pm 12.00 1.00am 2.00am 3.00am 4.00am 5.00am Every hour (except when you are asleep) write down the current intensity of your pain & how distressed you are by it. Write a brief description of your main activities during the hour. Note the name/number of any medicine/tablets you took during the hour. When relevant - note pain location, mood and other general remarks in the comments column.
Pages to are hidden for
"DAILY PAIN DIARY"Please download to view full document