Pain diary if pain does not seem to diminish

A pain diary can provide insight if the pain does not seem to diminish during recovery. By recording the experienced pain together with your possibilities and the pain medication you have used, you could get a better understanding of the course of your rehabilitation process. You might be surprised by the outcome.

What is a pain diary and how and why do I use a pain diary in physiotherapy.

In a rehabilitation process it is rather common that people have the impression that the pain does not diminish. This could have one of the following causes:

  1. Something goes wrong during rehabilitation. We have to figure out what goes wrong, why, and what we can do about it.
  2. Nothing goes wrong, we’ll explain below what is happening during the rehabilitation process.

This calls for an explanation

A few weeks after surgery you can still experience a lot of pain. This may make you anxious and understandably so.

When you would keep a regular pain diary you write down the experienced pain (with 0 for no pain and 10 for excruciating pain), and stiffness, and for the activity that made the pain worse.  As a physiotherapist I also have to fill in questionnaires for the insurance company to show how my patients (and I of course) are progressing. Those questionnaires are scientifically approved. They take time to fill in , and more time to evaluate.

I am not a scientist and I don’t do scientific research. I just want to evaluate quickly the progress my patients and give them immediate feedback. I also think it is important that my patients have a way themselves to tell wether they are doing well or not.

So I ask only four questions to my patients: this gives more insight to your progress

  1. How much pain do you have, from 0 to 10? This gives an impression of the amount of pain experienced.
  2. Which and how many painkillers do you take at the moment? If you increase the amount of pain medication and you still experience the same level of pain, the pain has technically increased. This is reason for alarm. If the amount or type of painkillers is reduced while the pain remains stable, then that is a good sign.
  3. How often does the pain you experience occur? Right after surgery there might be a score of 8 all day long, later only certain movements provoke that much pain, while the over all pain level reduced to 3. That clearly is a big improvement.
  4. What can you do now? Assess the activities that you perform (mobility, what you do and how long). If someone could barely get out of bed after the operation, and he can now walk a few blocks, that is a huge improvement, even when he experiences the same amount of pain.

So there you are: these four questions provide a correct and insightful picture. While only focussing on pain, someone will get anxious for the wrong reasons, but when asked those four questions, rehabilitation is put in perspective. Then you know wether you have reasons for anxiety or you are on the right track.

It consider it my duty not only doing the right exercises but also providing the right perspective.

A conversation about backpain:

He: the pain hardly diminishes, at first it was an 8, now it’s a 7. What is wrong?
I: The pain was an 8 with 6 paracetamols and muscle relaxants, you could not get out of bed, now it is a 7, with at most 4 paracetamols and no muscle relaxants, and you came walking to my office. You have progressed tremendously. The pain is probably, usually, the last thing that diminishes. Usually, my clients focus on improving their mobility (and regaining their normal level of activity) first and see their pain drop eventually. 

Why a pain diary?

  1. Our worst misery is quickly forgotten. We know it was bad, but not how bad it really was. Therefore we don’t see how much better we became already.
  2. It is in our nature to go forward, even if it hurts. People do as much as possible despite the pain.
  3. As a result, the possibilities, the freedom of movement, the action radius often increase first, and only later on the pain diminishes. We do not want to wait until the pain is completely gone.
  4. We have no patience with being ill. For most of us, our recovery is never fast enough.
  5. Our body needs time to recover. You have to be patient.

Pain diaryI give most of my patients the assignment to keep this pain diary with those questions. Daily recording is fine but not necessary. Comparing every day with the day before is not helpful because rehabilitation takes time. Compare your recordings once a week. If the pain diary does not show any improvement, you can show it to your doctor and talk about it.

Summary: What is in the diary?

  1. Date
  2. Pain. Rate it between 0 and 10
  3. Pain, how often, when?
  4. Medication. Which an how many do I take?
  5. Asses your daily activities: how many minutes did I walk, sit, sport, etcetera.
  6. I still have issues with …….?
  7. What sort of issues, how big are these issues?

More information about this subject:

Problems after knee surgery like pain, swelling and stiff knee

Arthrofibrosis, scar tissue in the knee, a possible complication after knee surgery with pain and limited movement

Taking up sports after knee surgery

Conclusions about this pain diary

This pain diary gives lot of insight and often also great relief. I think you could benefit from keeping this diary. Give it a try.

I am centainly interested in your vision.

 

 

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