A printable Chronic pain symptom diary, with a box for every day.

A week of chronic pain on one A4 page. Each row is a symptom people living with chronic pain often keep an eye on, and each column is a day. Tick the days a symptom showed up, or write 0 to 3 for how much it got in the way, and by the appointment the week has already told its story.

Pain that lasts beyond three months stops behaving like an injury and starts shaping everything around it: sleep, mood, what you agree to, what you quietly stop doing. It's often invisible, frequently doubted, and difficult to describe on demand, because the question how bad is it out of ten flattens something that changes hour by hour.

The list is a starting point, not a test. Cross out anything that is not you and use the empty rows for what is. It describes a week; it does not say what is causing it, and only a clinician can work that out with you.

No sign-up. Print it, or download it as a PDF. To print, press Ctrl and P, or Command and P on a Mac, and only the sheet below goes on the paper. Everything else, including this paragraph, is left off it.

Download as PDF

How to use it

• Print it on a day that is not too hard, and keep it somewhere you will see it
• Each evening, tick the symptoms that showed up, or write 0 to 3 for how much they got in the way
• Use the lines at the bottom for what helped and what made things worse
• Take two or three weeks of sheets to your appointment, or copy the pattern onto the symptom summary sheet

Printing these sheets for other people

You're welcome to print or photocopy these sheets and hand them out on paper, as many copies as you need, and you don't have to ask us first. That includes support groups, charity volunteers, ward and clinic staff, libraries, schools, and anyone helping someone else keep a record. There's nothing to pay and nothing to sign.

Questions people ask

Does ticking most of these mean I have Chronic pain?

No. The list describes what chronic pain can involve for many people. It does not tell you what is causing your symptoms, and ticking few or many of them proves nothing either way. Take the filled-in sheet to a clinician, who can look at the whole picture with you.

What if my symptoms are not on the list?

Use the empty rows, or cross out what does not apply and write your own. The symptoms printed here are a starting point, taken from the NHS and charity information linked on our Chronic pain page, and from what people living with chronic pain tell us they keep an eye on.

Can I use this without the app?

Yes. The sheet is complete on its own, and it does not know whether you use taluvu. If you would rather keep the same record on a phone, taluvu starts you with this same list when you choose Chronic pain.

More sheets, and where to go next

• Chronic pain symptom tracker, with the checklist on screen
• Printable question sheet for a GP appointment
• Printable flare log
• Printable symptom summary for a doctor
• Printable symptom diary
• How to prepare for a GP appointment
• What to include in a symptom summary for your doctor

If you would rather not write it by hand

taluvu is a chronic illness tracker for iPhone and for your web browser that keeps the same kind of record in about a minute a day, and turns it into a summary you can take to an appointment. The sheet above works perfectly well on its own.

taluvu Chronic Illness Tracker

TALUVU LTD · Health and Fitness · iPhone

Free to download, with a taluvu Pro subscription inside

taluvu Chronic Illness Tracker

TALUVU LTD · Health and Fitness · Computer

Start with a free week of taluvu Pro, in your web browser

Open in your web browser

Nothing on this page is medical advice. If you are worried about your health, contact your GP practice or NHS 111. In an emergency ring 999, and if you are struggling to keep yourself safe, Samaritans are on 116 123. How we write these pages.