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Pain Tracker

When you visit the doctor, it can be helpful to have a record of your pain.

This diary will help you track the frequency and intensity of your pain. And it may reveal a pattern that will help you and your doctor identify a successful treatment plan.


Duration (Include start time/end time):

Type of Pain (dull, aching, hot, throbbing):

How painful? (Rate the pain: 1=mild, 2=moderate, 3=severe):

Possible Causes (Did something trigger the pain?):

Medication (What did you take? Did it help?):

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