Free Printable Pain Diary Template for Your Doctor
Free printable pain diary
Download the free printable pain diary below and print as many copies as you need. It is a 6-page PDF for US Letter paper, with one week per page and a one-page monthly overview to put on top for your doctor. For food, medicines, periods and appointments, see all our free printables.
Free PDF, 6 pages, US Letter. Prints in black and white.
Download the pain diary (PDF)How to fill it in
- Fill in one row each evening, on days without pain too.
- Circle your worst pain score for the day, where 0 is no pain and 10 is the worst pain you can imagine.
- Write where it hurt, what the pain stopped you doing, and each medicine with the dose and time.
- Put a dot for the day's score on the monthly overview, and join the dots to show the pattern.
- At the end of the month, fill in the totals, shade the body map, and write your questions.
- Take the monthly overview to your appointment, with the weekly pages behind it.
Quick answer: what should a pain diary for your doctor include?
A pain diary for your doctor should record when the pain happens, where it is, what it feels like, how bad it is, how long it lasts, what makes it better or worse, and what it stops you from doing. Add where you are in your menstrual cycle and any other symptoms, such as heavy bleeding or pain when you poo or pee.
A record of your pain can help find its cause, and a doctor may ask you to keep a pain journal. Give your GP as much information about your symptoms as you can. A pain and symptom diary helps you remember the details at your appointment.
Why a diary helps
Pelvic pain can have many causes, which makes it hard to diagnose. A doctor also has limited time, and it is hard to remember how you felt weeks ago when you are sitting in the appointment.
A careful history of pain, heavy bleeding, and other symptoms can help with the diagnosis of endometriosis. A diary gives the doctor that history in dates and numbers.
What to record each time you have pain
These are the points to cover in a pain journal. For each episode, note:
When it happens
- The date and time of day
- Where you are in your menstrual cycle
- Whether it comes before, during, or after eating, peeing, pooing, sex, exercise, or sleep
What it feels like
- Sharp and stabbing, or a dull ache
- Coming in waves, or steady
- How long it lasts
How bad it is
Use the same 0 to 10 scale every time, where 0 is no pain and 10 is the worst pain you can imagine. Record the worst score for the day, so days are easy to compare.
What it stops you doing
Your doctor should ask how the pain affects your daily life. Write down what you missed or could not do, such as work, school, sleep, sex, exercise, or plans with friends. "Missed two days of work" tells a doctor more than a score alone.
What makes it better or worse
Note every medicine and supplement you tried, with the dose and time, prescription or not. Add other things, such as heat or rest, and whether they helped.
Map where it hurts
Note whether pain is mostly in one place or over a broad area, and whether it is always in the same place. A simple body map makes this quicker to record and easier for a doctor to read.
- Use the body outline on the monthly overview page of the printable pain diary, or draw a simple outline of the front and back of the body.
- Mark each area of pain, for example lower left tummy, lower back, or inside the vagina.
- Draw an arrow if the pain spreads, for example into the bottom or down a leg.
- Use the same map each time, so you can compare months.
Pain in a new place, or pain that spreads further over time, is worth pointing out. Read more in Ovary Pain During Your Period and Leg Pain During Period.
Record other symptoms too
Pelvic pain often comes with other symptoms that help a doctor narrow down the cause. These are some of the symptoms of endometriosis:
- Heavy periods
- Pain during or after sex
- Pain when you poo or pee
- Extreme tiredness
- Low mood or anxiety
Note bloating, nausea, bleeding between periods, and anything else that seems to follow a pattern. Read the full list in 20 Symptoms of Endometriosis and What the Pain Feels Like.
How long to keep the diary
Aim for two or three menstrual cycles before a routine appointment, so patterns can show. You do not need to wait for a full record before you see a doctor. Start the diary now and bring what you have.
Get urgent help
Do not wait to finish a diary if you have sudden, severe pelvic pain. Call 999 or go to A&E if you have pelvic pain and any of these signs: it is severe, you feel faint or pass out, you have pain in the tip of your shoulder, you have heavy bleeding, you have difficulty breathing, or you suddenly feel confused.
How to share it with your doctor
A full diary is hard to read in a short appointment. Bring a one-page summary on top. The monthly overview page of the printable diary has space for each of these:
- Your three main symptoms, and how long you have had them
- How many days each month you have pain, and your usual worst score
- Where the pain is, with your body map
- What it stops you doing
- What you have tried, and what happened
- Your questions
Keep the full diary with you in case the doctor wants the details. The Endolog symptom tracker app records pain by body location alongside your cycle and exports this kind of summary as a report. If you do not have a diagnosis yet, the endometriosis symptom quiz can help you put your symptoms in one place.
If you feel your symptoms are not being taken seriously, read Medical Gaslighting and Endometriosis: What to Say and Do.
FAQ: pain diaries
Paper or app?
Either works. Use whichever you will keep up with. An app can put dates, cycle days, and scores into a report for you. Paper works if you keep it in one place and use the same scale each time. The free printable pain diary above uses the same 0 to 10 scale on every page.
What if I miss days?
Record what you can. A few missing days do not make the rest of the diary less useful. Note when you start again.
Should I record days without pain?
Yes. Pain-free days show the pattern as clearly as pain days, and they help a doctor see how often pain happens.
Related articles
Sources
- Chronic Pelvic Pain, American College of Obstetricians and Gynecologists (ACOG)
- Endometriosis, NHS
- Visiting your doctor, Endometriosis UK
- Endometriosis fact sheet, World Health Organization
- Pelvic pain, NHS
This article is general information, not medical advice. Read how we write and check our articles in our editorial policy.
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