It has long been a common recommendation that chronic patients maintain a pain diary. The idea behind a pain diary is simple. Using either an electronic device or a paper journal, pain patients keep track of:
- Pain levels
- Foods eaten
- Activity level
- Types of activities (i.e., a regular work day or a vacation day)
- Medications taken
- Any thoughts on the day
The theory behind the recommendation is that doctors and patients can gain a better understanding of certain chronic pain syndromes than they might with simple patient reporting at a visit. Keeping track of pain levels allows a patient to give a more accurate reporting than trying to remember them on the day of the visit, especially if the patient is feeling particularly good or bad on the day they see the doctor. In theory, this allows doctors and patients to identify triggers and potentially avert painful episodes by changing behaviors.
But there is evidence that pain diaries might actually be making pain worse.
A small-scale study by the University of Alberta Faculty of Medicine & Dentistry found that keeping a pain diary actually lengthened the time of recovery for study participants who were recovering from lower back sprains. For four weeks, 58 patients in the study were divided into two equal groups, one of which was asked to keep a pain diary, documenting pain levels, and one of which did not. When patients were re-assessed at the four-month mark, the differences in the two groups were clear.
Robert Ferrari, a clinical professor in the Faculty of Medicine & Dentistry’s Department of Medicine and a practicing physician in several Edmonton medical clinics explains the results:
“What we found is that the group who kept the pain diary — even though we didn’t ask them to keep an extensive diary, and even though many of them didn’t keep a complete diary — had a much worse outcome. The self-reported recovery rates were 52% in the group that kept a pain diary and 79% recovery at three months in the group that did not keep a pain diary. That’s a fairly profound effect. There aren’t many things we do to patients in terms of treatment that affect the recovery for a group by 25%.”
These results are mirrored in study by Luis F. Buenaver, PhD, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. This study included 214 patients suffering from jaw and face pain due to temporomandibular joint disorder (TMJ). This condition can be acute or long-term but is very painful and can lead to sleep disturbances and other painful issues in the neck and upper back.
Buenaver and his colleagues examined each patient and then distributed questionnaires to ascertain participants’ pain levels, quality of sleep, and emotional response to pain. They were trying to see if patients tended to dwell on pain or exaggerate it. Those patients who did dwell on the pain were unable to shift their focus away from it when winding down for sleep, their pain was rated as much more severe, and patients’ sleep was more disturbed than those patients who did not focus on their pain.
So why do pain specialists continue to recommend keeping a pain diary when it seems as if it may make pain worse?
A pain diary can be a remarkable communication tool for you and your doctor. If you are living with chronic pain that has yet to be diagnosed, keeping a pain diary can help identify triggers or things that make pain worse. Keeping a pain diary can also identify times of day that pain is most prevalent, and it may be helpful in seeking reasonable work accommodations under the Americans with Disabilities Act (ADA).
There are many different ways to keep a pain diary. One of the easiest seems to be using apps for tracking chronic pain, widely available for free or a nominal fee for both iPhones and Android operating systems. If you choose to keep a pain diary and want to make it positive and forward-thinking, try these four tips:
- Add gratitude: Make a list of five things you are grateful for at the end of every day.
- Don’t make pain the focus: Think of it more as a daily journal. When pain symptoms are tracked or specifics are added, circle them or highlight in another color for easy reference, but focus more on telling the whole story of the day.
- Think outside of the page: Frida Kahlo, a painter who lived her entire life in excruciating pain, often painted her experiences while lying down. Your pain diary doesn’t have to be just words. You can illustrate your day or create a collage. Add photographs or bits of flotsam from your day (e.g., a key you found on a walk, a ticket stub from a movie, or a note from your child).
- Make it totally you: You are not your chronic pain. Yes, pain is part of your daily experience, but it does not make up the entire person you are. Use your pain diary as a way to explore your inner self, not just document an experience from one to ten.
The jury is still out on pain diaries. Do you keep one? Does it seem to help or hurt?
Image by Joel Montes de Oca via Flickr