An Example of a Pain Journal

Excerpt from Pain Foundation Journal

The journal includes:
1. Daily pain chart (with the times of the day)
2. Daily pain log (of which medicines you took and at what times of the day as well as therapies you took part in)
3. Daily pain summary

1. Did you have pain today?_no_yes
2. Did you avoid or limit any of your activities or cancel plans today because of pain or changes in your pain?_no_yes, What activities?_____
3. Did you take all your pain medicine today according to instruction? _no_yes
4. Even through you took your pain medicine for persistent pain on schedule, were there times during the day that you experienced unrelieved breakthrough pain?_no_yes
5. How many times did this happen today?

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Then the journal asks you about activities that may have set off your pain and to mark on a diagram of a body where you felt your pain

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The journal continues to ask you to really examine your pain and how you tried to handle it.

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You can change the journal however you need to. This is just one example of a pain journal that has helped other patients.

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You can receive a Pain Notebook for free by calling the toll free number:
1-888-615-7246 or going to the web page: www.painfoundation.org

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