Pain Diary Worksheet

Date &

Time

Describe your pain

Rate your pain (0-10)

What made your pain worse?

What helped you get through the day?

Describe your mood today

References


  1. Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150(3699), 971-979.
  2. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136.
  3. Jensen, M. P., Turner, J. A., & Romano, J. M. (1994). What is the maximum number of levels needed in pain intensity measurement? Pain, 58(3), 387-392.

You can download more Mental Health worksheets here.

Please note: There may be a more up-to-date and editable version of this worksheet available here which may be more suitable to present to clients if you are a therapist or to use in a classroom as a teacher or guidance counselor.

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