Pain Tracking Form

Instructions and Example Form

Those of you in pain can take these steps now.

  • 1. List every pain and symptom you have.

    Include every symptom/pain: numbness, tingling, weakness, neck pain, shoulder pain, leg pain, etc. If you have two different pains in your low back, list the two symptoms separately.

  • 2. Set up the form to record your pain.

    There is an example of the form recommended below. Some people need to use two sheets to have a column for every symptom/pain. It is easier to see patterns in your pain when using this form.

    Note:
    The first column is for the time of day
    The second column is for the activity
    The rest of the columns are set up so each pain and symptom have their own column.

  • 3. As you go through your day, track your pain.

    It is important to track the intensity, frequency and duration in measurable terms and connect it to the position/activity that caused or increased the pain.

    Note:
    In the activity column record the position/activity. Also record how long you were doing it before the pain started or increased.
    In the pain/symptom column record the intensity on a scale of 0-10. 0 is the least pain and 10 is the worst.
    The frequency is identified by looking at the whole form.

    This is not easy, try to not get frustrated. Record what happens. Work with that information with your PT. Make adjustments as needed, track when pain decreases as well as when it increases, add columns etc

  • 4. Develop a monitor for each position/activity that is painful - What they are.

    A monitor is a measurable description of the pain associated with position/activity. An example is, standing for 30 minutes causes pain of a 2/10 down the back of the leg. Intensity, Frequency and Duration are important measures (page 83 in the book Rescue Your Back.)

    Monitor examples:
    Wakes 0/10
    The pain down the back of the right leg is a 2/10 after standing for 30 minutes.
    The pain down the back of the right leg is a 5/10 after standing for 45 minutes.
    Sitting initially 0/10
    The 3 inch swath of pain across my low back is a 1/10 after sitting for 10 minutes.
    The 3 inch swath of pain across my low back is a 4/10 after sitting for 20 minutes.

    A monitor is also:
    The pain wakes me 3 times a night, 3 nights a week.
    The pain wakes me once a night the 4 other nights a week.

  • 5. Develop a monitor for each position/activity that is painful - Find a pattern

    Different days:
    Everyone had different days.
    Continue to track your pain to let the patterns for active days versus less active days reveal themselves.

    To develop your monitors:
    After tracking your pain, find the pattern for each pain.
    I find it is easiest to start with whether the pain increases when straight (standing, walking, lying in bed) or when bent, (sitting, reaching down, etc)

  • 6. Get help with monitors

    Help from a Physical Therapist:
    Figuring out the measurable circumstances can be difficult. Track your pain and find a PT who will work with you to iron out the details of describing each pain in measurable terms related to position/activity. It is the details about the pain and positions that help people with mechanical problems understand what is happening to the body.

    Monitors of the impact of specific positions on pain, in measurable terms, help:
    The patient gain more control over the pain.
    The physical therapist identify the mechanical problems causing the pain.
    develop an exercise program addressing mechanical problems that does not increase the pain.
    To know if function is improving in measurable terms.
    To make many decisions throughout the process about what the patient can do.
    To make healthy return to work decisions.

Example Form

Time of day Activity Left low back pain. Sharp. Size of quarter Across low back. Ache. Band 3″ wide.
7am
8 Driving
10 min 1/10
20 min 4/10
35 min 6/10
9 Standing
30 min 2/10
10 60 min 4/10
75 min 5/10
11 Sitting
5 min 0/10
10 min 1/10
20 min 4/10
12pm

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Disclaimer: This is not a self help resource and this does not replace an evaluation by your medical doctor or Licensed Physical Therapist.
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