DAILY PAIN DIARY by NvKrx4

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									                                   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.

								
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