Example of daily pain journal

Date: March 15

Day in Cycle: Day 4

Activities & Excercise: 30 Minute moring walk

Pain Level ( Scale of 1-10): 3

Type & location of pain + other sypmtoms: Cramping & pressure right below belly button.

How lond did pain last : 2 hours

Meds /Taken/ Effectiveness: 2 Tylenol every 4 hours (morderately effective)

1- Very minor annoyance - occasional minor twinges. / No medication needed.

2- Minor annoyance - occasional strong twinges./ No medication needed.

3- Annoying enough to be distracting /Mild painkillers are effective (i.e., aspirin, ibuprofen).

4-Can be ignored if you are really involved in your work, but still distracting. / Mild painkillers relieve pain for 3-4 hours

5-Can't be ignored for more than 30 minutes. / Mild painkillers reduce pain for 3-4 hours

6-Can't be ignored for any length of time, but you can still go to work and participate in social activities. / Stronger painkillers (Codeine, Vicodin) reduce pain for 3-4 hours.

7-Makes it difficult to concentrate, interferes with sleep You can still function with effort. Stronger painkillers are only partially effective. /Strongest painkillers relieve pain (Oxycontin, Morphine).

8-Physical activity severely limited. You can read and converse with effort. Nausea and dizziness set in as factors of pain./Stronger painkillers are minimally effective. Strongest painkillers reduce pain for 3-4 hours.

9-Unable to speak �?crying out or moaning uncontrollably �?near delirium. /Strongest painkillers are only partially effective.

10-Unconscious. Pain makes you pass out. /Strongest painkillers are only partially effective.