Today on Dr. Oz- Chronic Pain

DR. OZ “WHY YOUR DOCTOR THINKS YOU’RE CRAZY! IS YOUR CHRONIC PAIN A DISEASE?”
There is a growing epidemic your doctor may be ignoring. Your Pain: When To Worry

Learn to think about pain like a doctor. These four rules can help to uncover the root of your problem and find effective treatment. Today’s audience is filled with people afflicted with chronic pain as Dr. Oz helps to shed some light on the groundbreaking research proving its existence.

Audience members Hilary (Chalfont, PA), Jacqueline (Montclair, NJ) and Shelia (Hillsborough, NJ), who all suffer from severe chronic pain, share their emotional stories, and how their primary practitioners told them there is nothing wrong with them, and try and make them believe this pain is all in their head. Chronic pain sufferer and woman’s health advocate Dr. Donnica Moore teams up with Dr. Oz, Dr. Sean Mackey member of The Institute of Medicine Committee that released the ground breaking findings on chronic pain. Dr. Julie Silver Physiatrist, who specializes in pain management to disclose the best multi-dimensional treatment for chronic pain.

Dr. Oz today talked about chronic pain, your doctor thinks it’s in your head: your doctor isn’t telling you something and Dr. oz said a lot of doctor’s are going to be really angry after todays show. Plus Dr. Oz shares the worst and best treatments for your pain. Plus Dr. Oz’s 4 critical questions you need to ask your doctor about pain.

Dr. Oz started off this segment of the show saying a lot of doctor’s are going to be really angry about what he’s talking about today. Millions of people have been suffering from chronic pain and doctor’s haven’t been taking us seriously. There is ground breaking new science proving that chronic pain is real, it’s a disease and it’s not something you’re making up.

Dr. Oz spoke with one woman in the audience who has complained of back pain and leg pain and her doctor told her to go home and have more sex with her husband and that it would help with her pain and then proceeded to show her positions that might work.

Dr. Oz said he was Peed off and said it frustrates him that it’s hard for one to get proper treatment for pain and in his opinion doctor’s do think you are crazy, they think the pain is all in your head. There are 4 reasons why doctors won’t be able to help you with chronic pain like they should.

Why You Doctor Thinks You’re Crazy

1. Doctor’s Can’t See Your Pain – If they can’t see your pain it doesn’t exist

2. Doctor’s Don’t Have Pain Management Training

3. Doctor’s Think You’re Out To Score Some Drugs

4. You’re A Woman – Dr. Moore said male doctor’s treat female patients differently.

We can now call chronic pain a disease according to the new study released, the pain itself is a disease just like diabetes, heart disease and the like says Oz. Dr. Mackay said this study is now validating what chronic pain sufferers in the audience have been saying.

Dr. Oz 4 Questions To Find The Right Pain Specialist

Next we moved on the the 4 questions you need to ask to find a doctor to treat your chronic pain:

• How Much Pain Management Training Do You Have?
• What Is Your Approach?
• How Long Before I Begin To See Results?
• How Much Will It Cost

4 Rules

Dr. Silver is the author of You Can Heal Yourself and an award-winning book from the American Cancer Society titled What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope, here is what she says about When to Worry About Your Pain.

Learning to treat pain effectively takes years. As a medical doctor who specializes in Physical Medicine and Rehabilitation (PM&R), I have extensive training in treating pain. Doctors who specialize in PM&R are formally called physiatrists and are sometimes informally referred to as pain doctors.

One of the first things we learn is when to worry about pain. Since we are taught to treat so many different kinds of pain, we need to know when to sound an alarm about a patient’s condition and how to act to treat them most effectively. If you’ve been experiencing pain, it’s important that you learn to think like a pain doctor. While these “rules” about when to worry certainly do not cover every person and every situation, they are important to know to get to the source of your problem.

How to Think Like a Pain Doctor

1. Two-Week Rule 
Any pain that lasts for more than two weeks should be checked out. A lot of people think that new pain means that they have cancer. In fact, most new pain is due to bones, joints, nerves and other musculoskeletal structures. Many doctors use the two-week rule because a lot of musculoskeletal pain will resolve within a two-week period. Also, a two-week delay in diagnosis is very unlikely to change someone’s prognosis if the pain is due to cancer. Though the two-week rule applies to most pain, there are times when doctors ignore this rule and become immediately concerned (See Rules 2, 3 and 4).

2. Acute-Trauma Rule 
Doctors should immediately check all pain associated with acute trauma, such as a car accident or fall off a ladder. Usually, people aren’t overly worried that cancer is causing their pain if they have trauma that results in immediate or even slightly delayed pain. However, all pain associated with trauma necessitates an evaluation; this includes a physical examination and possible imaging tests such as x-rays or MRIs.

3. Worst Pain of My Life Rule
Doctors should be alarmed at any new and severe pain that a patient reports. It’s not unusual for a patient to actually say, “This is the worst pain I’ve ever experienced!” Often, the “worst pain of my life” is not cancer, but may be the result of something serious, such as a heart attack, appendicitis or ruptured blood vessel (aneurysm). If the pain is severe but chronic and has been worked up previously, then the “alarm bells” ring less vigorously.

4. I Can’t Sleep Rule
Doctors should be concerned about any pain that awakens a patient at night. Sometimes, night pain is more serious than pain that occurs during the day with normal activities. This is because, usually, when you rest, pain improves. Pain that doesn’t improve with rest is sometimes worrisome. However, resting too much with chronic pain leads to weakness and more pain. If you have chronic pain, try and alternate rest with activity to stay strong and keep your overall pain levels down. Cancer pain is one type of pain that often doesn’t improve with rest and will awaken people at night. However, it’s important to know that a lot of musculoskeletal pain problems will bother patients at night. Hip bursitis or shoulder tendinitis can often keep a patient awake if they lie on the affected side and put pressure on the injured part of the body. It’s important not to make assumptions about what is causing night pain, and to identify the cause and treat it appropriately.

There is no doubt that pain is undertreated and that physicians and patients need to work together to find solutions. When someone tells me, “I’ve tried everything,” I often ask if he or she has had a consultation with a physiatrist. Often the answer is no. To find out more about doctors in your area who specialize in treating pain and helping people to function at the highest possible level, visit the American Academy of Physical Medicine and Rehabilitation.

Source: doctoroz.com

http://www.doctoroz.com/

It’s Time to Become Disability-Aware

A Different Normal

Living with a Chronic Condition

Richard C. Senelick, MD is a physician specializing in both neurology and the subspecialty of neurorehabilitation. He is the Medical Director ofHealthSouth RIOSA, The Rehabilitation Institute of San Antonio, and an associate clinical professor in the Department of Neurology at the University of Texas Health Science Center in San Antonio. He has authored several books on stroke, spinal cord injuries, and brain injuries. Dr. Senelick is an expert in the WebMD Stroke Community.

Did you go see the movie Tropic Thunder?  Have you rented the movie, There’s Something About Mary? Both movies have scenes that generate laughs at the expense of the disabled. It may seem like “nit picking,” but had a different minority been similarly stereotyped, the outcry would have been much louder.  The disabled are a minority who still have a significant barrier to overcome. People rarely understand the simple fact that the disabled have the same desires, dreams and aspirations of able-bodied people.

I work every day with people who have disabilities.  I am the medical director of a rehabilitation hospital where I am surrounded by patients with brain injuries, missing limbs, severe deformities and impairments. This is my “normal” environment— one in which I am totally at ease and comfortable.  In fact, I have been doing this for so many years that I frequently don’t notice the alarm or discomfort of first time visitors.

By virtue of this familiarity, the assumption is that I have either learned or intuitively know how to interact appropriately with someone with a disability. In my world, it is the rare occasion where someone actually receives criticism or a comment related to something they said or did while interacting with a disabled individual.  But, the wars in Iraq and Afghanistan have produced large numbers of “wounded warriors” who have no qualms telling us what they want and how they want to be treated.  While caring for these young men and women, it has become apparent that it is time to “test” our own disability awareness and examine whether we act in an appropriate manner.

The difficulty here is that many people are simply not aware that even though their intentions are good, their words can come across as patronizing or insensitive. Below are a couple of common missteps in our interactions with the disabled.  See if these ring true and whether you need to reassess your approach.

Greetings: It is second nature to offer your arm and shake the hand of someone you have just met.  However, I have seen many people hesitate to shake the hand of a disabled person out of fear that the person is paralyzed or missing a limb.   Greetings come in a wide variety these days, from a fist bump to a high five.  Extend an arm in greeting and an individual will respond.  However, do not invade their personal space by assuming you can rub a shoulder or pat a knee without permission. Even in our increasingly casual society, it is not acceptable to call someone honey, sweetie, baby, sugar or – my least favorite current greeting — “dude.” A few years ago, I was a patient in the hospital and an aide asked me, “How you doin’, dude?”  If not for my wife’s restraining “not now” stare, I would have come unglued.

“You are so courageous”: I recently spoke with a young woman who told me, “I always make sure to tell people with disabilities whom I meet how courageous they are.”  The definition of courage is, “the mental or moral strength to withstand danger, fear or difficulty.” Yes, a soldier’s courageous act may have resulted in their injury, but now, they may feel afraid, anxious and depressed, and need someone to acknowledge and empathize with these emotions. It is not helpful for us to tell them they are courageous, for that sets an expectation that they must check their emotions at the door and show an “expected” strength at a time when they are barely coping.

“It could have been worse”: Don’t tell a disabled person how “lucky” they are or that it could have been worse.  It diminishes the importance of the event or illness.  Statements like this come off as judgmental about the impact of the injury on that individual.  If you had a stroke that left you with the ability to walk but you still had a paralyzed arm, would you feel lucky?

“I know how you feel”: You should avoid the use of phrases such as, “I know how you feel” or, “I can imagine what it must feel like.”  Unless you have the same or similar disability, you do not know how they feel.  It is better to say, “I have never had to sit in your chair nor walk in your shoes.  I hope that I never have to, but I will be here to help you get through this difficult time.” Empathy without sympathy.  Assistance without patronization.

We recently watched moving memorials for those who died on September 11, 2001.  Ten years later we have tens of thousands of soldiers who have unfortunately joined the 5.6 million Americans who have to live in wheelchairs.   Will we honor their “new normal” with appropriate social interactions and greetings? You may say, “Of course, I will.”  But I challenge you to go a step further and become a disability etiquette educator.  Spread awareness among your co-workers, your associates and your family. And, from time to time, it never hurts to look in the mirror.

Coping - Family Involvement

Expert advice from Leslie Epstein, M.S., MFCC

While only one person in a family may suffer from fibromyalgia the entire family is affected by it. Your family faces a troublesome time while learning to cope with the anxieties, fears and trauma produced by fibromyalgia. Thus, it is essential that the family become part of your therapeutic program. More explicitly, family support is crucial to the successful management of any chronic and painful condition.

A common problem for patients is disassociation, where a family member may want to deny that their is anything wrong with you. That family member seems to feel that if he/she pretends nothing serious exists, the illness and its problems will go away. This type of person rationalizes that "if their is nothing I can do (about my loved one having fibromyalgia), I may as well act as if nothing is wrong and go on living my own life." The patient, in turn, resents this apparent disinterest and interprets it incorrectly to mean that their family member does not care, creating added stress.

Open communication among family members is important. The family must learn to discuss all feelings that arise, including frustration, resentment and impatience. Expression must not be restricted. The patient should be comfortable discussing personal needs and feelings with the family, and the converse should also be true. In this connection, it is vital that changes in family roles and responsibilities be discussed openly in order to prevent repressed anger and resentment, since hostile family attitudes may cause a patient's symptoms to flare.

The difficulty seems to be in finding the best response at a particular time: empathy when the symptoms appear to be worse; support during times of fear and crisis; and allowing patient control in periods when they are feeling better. Thus, a good system of communication within your family is essential.

Finally, family members are not immune to depression. It is frustrating to watch people who are sick and in pain, and yet to have little control over their illness. This can anger family members, who typically are unwilling to vent their frustrations onto you for fear of inducing more stress and causing an exacerbation of your condition. Instead, the family member's anger turns inward, creating depression.

Maintaining Healthy Relationships with your spouse, partner, children, family, friends, and others. 20 experts in the field answer questions posed by fibromyalgia patients in this specially crafted, 20-page Special Issue: Explaining your limits to others Handling demands on your time Helping children understand your illness Enjoying intimacy in spite of your pain and fatigue Saying "No" without regrets Handling unwanted advice Controlling angry outbursts Don't let chronic illness interfere with your ties to family and friends. Get our Special issues on Relationships

Fibromyalgia Network

If you haven't subscribed to these guys (FM Network http://www.fmnetnews.com), I HIGHLY recommend it. They send out awesome newsletter's in the mail every other month. They do survey's from members and post results in there. Also every month there is an E-Newsletter that is as good or better than the print version. I've been with them for 6 years now. They also have an 800 # if you need ANYTHING you can call them. From references to good doctors, to just a shoulder to cry on. (BENEFITS: http://www.fmnetnews.com/about-benefits.php) I have 6 years worth of these newsletters collected and the articles 98% pertain to me. Which is hard to find. Here I'm going to give you some links and info about the company and what the website has to offer since the website is rather confusing.


Main Site: http://www.fmnetnews.com/index.php
Here you can sign up for free articles too and has a basic intro of what the newsletters are about.


Facebook Page: This may make more sense to us now days. Check it out! :D


Site Map: This helps clear up the confusion of the website and give you an idea what they are all about as well.


The Store: Finally, here's where you become a member, get your stuff and benefits. Just click "Click here to Join" Also they are always giving away some free stuff with membership too. So watch for those. 


Here's what I got free with mine, it costs $5 on the site now. This list is a little outdated now, but still an awesome reference!! If you'd like this emailed to you let me know by email. Email me here

FYI: Data did not fit on main page. If you go across the tabs at the top and look for "Resources/Downloads" and click that, go all the way to the bottom of the page and the Top 25 Fibromyalgia Medications and an E-Newsletter are posted there. If you want anything else for a preview before purchasing a membership, let me know with this email. Email me here

Fibromyalgia: Healing Begins

Fibromyalgia Effects My Entire Life

PAIN Inspirational

P= Perserverance, the tenacity you need to get through your illness!

A= Attitude, your attitude determines your altitude! Keep your thoughts positive.

I= Initiate, Initiate your future by keeping close to family and friends. Don't   isolate.

N= NEVER, ever, give up or loose hope.  Your breakthrough 

Hope

Fibromyalgia is god's way of saying, your tougher than the rest and you can handle it.

Chronic Pain: OTC or Prescription Medicine?

I came across this article in my email. I find it very interesting. There's 4 pages to it. Thought I would share it with you all. Let me know what you all think, comment below please. Thanks!!

http://www.webmd.com/pain-management/features/when-to-call-doctor

Fibromyalgia Tender Points

Fibromyalgia syndrome is a common disorder characterized by multiple tender points, widespread deep muscle pain, fatigue, and depression. The term fibromyalgia comes from the Latin word for fibrous tissue (fibro) and the Greek terms for muscle (myo) and pain(algia).

What are tender points?

Tender points are pain points or localized areas of tenderness around joints, but not the joints themselves. These tender points hurt when pressed with a finger.

Tender points are often not deep areas of pain. Instead, they are superficial areas seemingly under the surface of the skin, such as the area over the elbow or shoulder.

Are tender points large areas of pain?

No. The actual size of the point of most tenderness is usually very small, about the size of a penny. These areas are much more sensitive than other nearby areas. In fact, pressure on one of the tender points with a finger will cause pain that makes the person flinch or pull back. Tender points are scattered over the neck, back, chest, elbows, hips, buttocks, and knees.

What causes tender points?

The cause of these pressure points is not known. Even though it would seem these areas might be inflamed, researchers have not found particular signs of inflammation when examining the tissue. What is known is that the locations of tender points are not random. They occur in predictable places on the body. That means many people with fibromyalgia experience similar symptoms with tender points.

Can my doctor diagnose fibromyalgia from the tender points?

Your doctor can test the painful tender points during an examination.Yet even with tender points, you need to tell your doctor about the exact pain you feel in those areas. You also need to tell the doctor about your other symptoms of fibromyalgia, such as deep muscle pain, fatigue, sleep problems, depression, irritable bowel syndrome, and more.

If you don't explain all your fibromyalgia symptoms fully to your doctor, the doctor will not be able to effectively treat the fibromyalgia. As a result, you won't get good relief from the chronic pain and other symptoms.

When a doctor tests tender points for pain, he or she will also check "control" points or other non-tender points on your body to make sure you don't react to these as well. Some physicians use a special instrument called a "doximeter" or "dolorimeter" to apply just the right amount of pressure on tender points.

How many tender points are important for fibromyalgia?

There are 18 tender points important for the diagnosis of fibromyalgia (see illustration below). These tender point are located at various places on your body. To get a medical diagnosis of fibromyalgia, 11 of 18 tender point sites must be painful when pressed. In addition, for a diagnosis of fibromyalgia, the symptom of widespread pain must have been present for three months.

Is there a prescription medication that eases the pain of tender points?

Pain management for tender points with fibromyalgia involves a multifaceted treatment program that employs both conventional and alternative therapies. While the reason is not entirely clear, fibromyalgia pain and fatigue sometimes respond to low doses of antidepressants. However, the standard treatment for fibromyalgia and tender points involves medications, daily stress management, exercise, hydrotherapy using heat and ice, and rest. Other remedies for symptoms may also be used.

What at-home treatments might help in managing tender point pain?

Alternative treatments or home remedies are important in managing fibromyalgia and the pain of tender points. As an example, therapeutic massage can manipulate the muscles and soft tissues of the body to help ease pain, muscle tension, spasms, and stress.

Twice daily moist heat applications are also helpful in easing the deep muscle pain and stiffness. To benefit from moist heat, you can use a moist heating pad, warm shower, or a heat "cozy" that you warm in the microwave. You can also relax in a Jacuzzi.

With fibromyalgia, it's extremely important to manage your schedule and to control your level of stress. Be sure to block time each day to rest and relax. Avoid making too many commitments that can increase stress and fatigue. In addition, you can do relaxation exercises such as guided imagery, deep-breathing exercises, or the relaxation response to manage how you respond to stress.

Staying on a regular bedtime routine is also important. Doing so allows your body to rest and repair itself. In addition, regular exercise is vital to managing the pain, depression, and other symptoms of fibromyalgia.

What can make fibromyalgia symptoms and tender point pain worse?

A number of factors can make fibromyalgia symptoms worse. They include:

• Anxiety
• Changes in weather -- for example, cold or humidity
• Depression
• Fatigue
• Hormonal fluctuations such as PMS or menopause
• Infections
• Lack of sleep or restless sleep
• Periods of emotional stress
• Physical exhaustion
• Sedentary lifestyle

Tender Points in Fibromyalgia

Reviewed by Brunilda Nazario, MD on April 30, 2009

© 2009 WebMD, LLC. All rights reserved.

Chronic Opioid Therapy

Chronic Opioid Therapy

Preparing for Your Appointments

We may have done this a million times. But I did this worksheet the other day and found it very useful and my doctor thought it was very eye opening as well. This is another document from the American Pain Foundation. I hope you find it useful as well. 

http://www.painknowledge.org/physiciantools/COT/COT_Preparing_for_Appts.pdf

Chronic Opioid Therapy

Chronic Opioid Therapy

Dos and Don’ts to Help Avoid Problem

Using Opioids Safely and Responsibly

If you are a family member, friend or patient. This is very important!

This is a very tough subject for a lot of us. I thought this really needed to be addressed and found this wonderful resource from the American Pain Foundation. Please take the time to read this very short document. 

http://www.painknowledge.org/physiciantools/COT/COT_Dos_and_Donts.pdf

Patient Guide to Pain Care Providers

The following information is designed to empower you with the understanding of different types of doctors, based on their background, training, specialty, added qualifications and clinic setting. This is intended to help you make informed decisions for your pain care. Regardless of how you find potential providers, you the person in pain should know what credentials your physician has to treat pain and the type of pain clinic that you have chosen to visit.

http://www.nationalpainfoundation.org/dis_cond/Patient%20Guide%20to%20Pain%20Care%20Providers.pdf

The "Ugly" Truth about Myofascial Pain Syndrome

To explain this Myofasical Pain Syndrome further in terms we can all understand, I was reading one of my books entitled "Fibromyalgia and Chronic Myofascial Pain. A Survival Manual. 2nd Edition" by Devin Starlanyl and Mary Ellen Copeland. Mind you this is the only book I've ever found of the two subjects mixed together. Anyways, point being that, if you imagine a piece of uncooked chicken. The skin is slimmey and slippery and moves about very easily. Now imagine your neck for example is made of human skin, underneath is "chicken skin", (I know lots in between), then bone, then more "chicken skin" then human skin again. Everyone without Chronic Myofascial Pain Syndrome moves that "chicken skin" around very easily. You don't have an issue checking your blind spot while driving, or turning your head when someone yells your name out in a crowd. Then there's me, and maybe you, if you have this unfortunate diagnosis. This "chicken skin" has turned into concrete. Yep, hard as a rock, can't hardly move an inch, rebar and all...Concrete. Now you add in good old Fibromyalgia which most of you are now familiar with and what do we have? A very painful experience my friends, So, next time you ask why I hurt so bad...thank your lucky "Chicken Skins"


Amanda Lakso
May 26 2011 7:47pm

Myofascial Pain Syndrome

Myofascial pain syndrome (MPS), also known as Chronic myofascial pain (CMP), is a condition characterized by chronic and, in some cases, severe pain. It is associated primarily with "trigger points", localized and sometimes extremely painful lumps or nodules in any of the body's muscles or connective tissue known as fascia. Other symptoms include referred pain, restricted movement, and sleep disturbances.


Symptoms:


Myofascial pain can occur in distinct, isolated areas of the body, and because any muscle or fascia may be affected, this may cause a variety of localized symptoms. More generally speaking, the muscular pain is steady, aching, and deep. Depending on the case and location the intensity can range from mild discomfort to excruciating and "lightning-like". Knots may be visible or felt beneath the skin. The pain does not resolve on its own, even after typical first-aid self-care such as ice, heat, and rest.


Further Info:


http://en.wikipedia.org/wiki/Myofascial_pain_syndrome


http://www.webmd.com/pain-management/guide/myofascial-pain-syndrome


http://www.mayoclinic.com/health/myofascial-pain-syndrome/DS01042

Zen Meditation Can Help Bring Pain Under Control

People who engage in Zen meditation do feel pain, new research reveals, but they don't think about it as much.


The observation could have a bearing on the treatment of chronic pain among patients struggling with the impact of conditions such as arthritis and back pain.



Pierre Rainville, a researcher at the University of Montreal, and his colleagues report their findings in the journal Pain.


"Our previous research found that Zen meditators have lower pain sensitivity," said senior author Rainville in a news release from the journal. "The aim of the current study was to determine how they are achieving this."


"Using functional magnetic resonance imaging [MRI], we demonstrated that although the meditators were aware of the pain, this sensation wasn't processed in the part of their brains responsible for appraisal, reasoning or memory formation," Rainville noted. "We think that they feel the sensations, but cut the process short, refraining from interpretation or labeling of the stimuli as painful."


The authors' observations stem from work with 13 Zen meditators exposed to a painful heat stimulus.


Functional MRIs were conducted of the meditators' brains as the team gathered their self-reported perceptions of pain.


Compared with an equal number of non-meditating study participants, the researchers found that highly experienced meditators reported lower pain responses, as well as less activity in those parts of the brain (the prefrontal cortex, amygdala and hippocampus) that are linked to cognitive processes, emotion and memory.


"Our findings lead to new insights into mind/brain function," study first author Joshua Grant, a doctoral student at the university, said in the same news release. "These results challenge current concepts of mental control, which is thought to be achieved by increasing cognitive activity or effort. Instead, we suggest it is possible to self-regulate in a more passive manner, by turning off certain areas of the brain, which in this case are normally involved in processing pain."


"The results suggest that Zen meditators may have a training-related ability to disengage some higher-order brain processes, while still experiencing the stimulus," added Rainville. "Such an ability could have widespread and profound implications for pain and emotion regulation and cognitive control. This behavior is consistent with the mindset of Zen and with the notion of mindfulness."


For more on meditation, visit the U.S. National Center for Complementary and Alternative Medicine.


Resource: http://www.healthscout.com/news/1/647215/main.html

Why It's Important to Keep a Pain Diary

Why It's Important to Keep a Pain Diary and resources to keep track of it. Both old fashion and phone apps.

Your doctor needs detailed data to plot out the causes and triggers of your chronic pain and build a treatment plan. When she asks how you have been in the past month or two, you need to be ready to provide specifics.

"My back is bothering me worse than ever" won't help your doctor. One solution pain doctors recommend is keeping a pain diary, a consistent record of your pain experience.

Your doctor will be looking for triggers, stresses, and patterns. The more detailed you can be about the factors that seem to influence your pain, the better. 

• Rate your pain on the pain scale at different times of the day.
• Indicate whether your pain interrupts daily activities like walking, working, or sleeping.
• Note what meds you took, when you took them, how much relief they provided, and for how long.
• Describe other treatments you may have tried (yoga, herbal remedies,nonprescription drugs), and whether they provided any relief.
• Note any side effects of pain medicine.
• Keep track of anything that makes the pain improve (better when you are sitting instead of standing, better after a hot shower, etc.)

Consistency is the key. If you make notes in your diary on a regular basis (several times a week), you'll have a complete picture of your pain experience and patterns will emerge. 

Watch for surprises and patterns
You may notice some unusual connections. The stress of making dinner in the evening may cause that stabbing pain to return, or an argument with your daughter may make your back hurt more than usual.

Andrea Cooper, 52, of Phoenix, Md., has found her pain diary invaluable for keeping track of her fibromyalgia. "I saw that my pain would peak at certain times of the day," she says. "Even when I was on pain medication, I still found the pain had an upward climb at the end of day. I was able to take that to the doctor, and when he looked at it he said 'Gee whiz, your pain medicine is not getting you through the day. We need to do something about that spike.' He changed my medication and things improved."

Don't get addicted to the pain diary
Cooper does warn, however, of the danger of focusing so much on your pain that you obsessively fill in an entry every hour of the day. "That can backfire," she says, because "we all know that focusing on something that's bothering us will make it worse."

Cooper takes quick notes during the day and then writes a longer entry at the end of the day.

Download a pain diary
The not-for-profit American Pain Foundation has an excellent pain notebook that you can download for free. Also check out our print-and-carry list of what to keep in your pain diary.

Resourse: http://www.health.com/health/condition-article/0,,20188145,00.html

Other recourses for pain dairy's:

Free Pain Diary Worksheet:

http://www.docstoc.com/docs/30680755/Pain-Diary-Worksheet

http://www.freeprintablemedicalforms.com/preview/Pain_Level_Chart

http://www.healthinaging.org/public_education/pain/my_pain_diary.pdf

http://docs.google.com/gview?url=http://www.whatworksforpain.com/wp-content/uploads/2010/04/Initial-Pain-Diary.pdf&hl=en_US&gdet&chrome=true

iPhone or iPad Apps to track your pain:

This is my favorite app. You can do SO much with it and even send the data to yourself or your doctor in spreadsheets. It's amazing! I use the free one. Not sure what the paid one has in addition.

http://itunes.apple.com/us/app/chronic-pain-tracker-lite/id330294651?mt=8

More info about app here: http://www.chronicstimulation.com/index_files/PainTracker.htm?gclid=CIyz--Gd2agCFYjsKgodtkQXEQ

Here's another favorite:

http://itunes.apple.com/us/app/pain-care/id347787779?mt=8

One more also has reports and tracking for long term for your doctor:

http://itunes.apple.com/us/app/my-pain-diary-lite/id343171869?mt=8

I don't have an Android, but here are some apps I found that look pretty good:

https://market.android.com/details?id=pack.joyg.painscale&feature=search_result

Pain care as mentioned above on iPhone apps but for Droid:

https://market.android.com/details?id=com.stanislav.android&feature=search_result

Symptom Tracker Pro:

https://market.android.com/details?id=com.ToTheHand.GenericTracker

Hope these tools are useful. Do what works for you. Good luck!