📊 Pain Management Tracker

30-Day Daily Pain Log for Crutch Users

How to Use This Tracker

Why track your pain? Understanding your pain patterns helps you and your doctor make better treatment decisions. This tracker captures:

Tips: Fill out your log at the same time each evening. Be honest and specific. Bring completed logs to doctor appointments for better communication.

Patient Information

Pain Scale Reference (0-10)

0
No Pain
1-3
Mild
Annoying but manageable
4-6
Moderate
Interferes with activities
7-9
Severe
Disabling, can't ignore
10
Worst Possible
Emergency level

Day 1 of 30

📍 Pain Location (Check all that apply)

Upper Body
Lower Body

📊 Pain Intensity Throughout the Day

Morning (6am-12pm):
Pain Level:
Afternoon (12pm-6pm):
Pain Level:
Evening (6pm-12am):
Pain Level:

💊 Medications Taken Today

🎯 Pain Triggers (What made pain worse?)

✅ Pain Relief (What helped?)

😴 Sleep Quality & 💪 Energy Level

📝 Daily Activity & Notes

Day 2 of 30

📍 Pain Location

Upper Body
Lower Body

📊 Pain Intensity

Morning:
Afternoon:
Evening:

💊 Medications Taken

🎯 Pain Triggers

✅ Pain Relief

😴 Sleep: _____ hrs | Quality (0-10): _____ | 💪 Energy (0-10): _____

📝 Notes

📧 Questions or need support? Email us at [email protected]

Pain Management Tracker © November 2025 CrutchesGuide.com

This tracker is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your pain management.