Back pain is the most common pain complaint there is - and at the same time the one where memory blurs fastest. "The last few weeks were bad" is only so useful in the consulting room. How many days were affected? Did it get worse after the move, or was it already like that before? Did the physiotherapy achieve anything?
A pain diary answers exactly those questions. With back pain, though, something different matters than with headache: the focus is not the individual attack but load, posture and the course of the day.
Why back pain in particular benefits from documentation
- The trend determines the assessment. Whether symptoms subside, recur or become permanent can only be judged across weeks - not at a single snapshot appointment.
- The triggers are everyday and therefore invisible. Long periods of sitting, an unfamiliar lifting job, a short night: individually these things go unnoticed, but they show up in a pattern across four weeks.
- Movement works in both directions. It is a central part of treating persistent back pain, but in the short term it can also hurt more. Without records it is hard to tell which of the two is happening.
- Judging a treatment needs a "before". Specialists recommend starting the diary four weeks before treatment begins where possible. Without a baseline, any later improvement remains a matter of feeling.
What you should record
For the back, this selection has proven itself - compact enough to keep up:
- Date and time. Only then does it become visible whether it is worst in the morning, after the working day or at night.
- Intensity on a fixed scale, usually 0–10. How to arrive at comparable values is covered in The 0 to 10 pain scale.
- Location. Lower back, thoracic spine, neck, left or right - and whether the pain stays in one place.
- Radiation. Does it travel into the buttock, the leg, the arm? This detail is medically particularly relevant.
- Type. Pulling, pressing, stabbing, dull or cramping.
- Load before the pain. Long periods of sitting, standing, carrying, driving, unfamiliar movement - or conspicuously little movement.
- Duration. Minutes, hours or continuous.
- Measure and effect. Heat, movement, stretching, lying down, medication - and whether it helped.
Points 1 to 3 are the core. If you only have 20 seconds on a given day, time and intensity are enough. Everything else is context that makes the entry more valuable but must not stop it from happening.
Time of day beats peak value
The most common mistake with back pain is noting a single number for the whole day in the evening - usually the one from the worst moment. That loses the most important information: when it was bad.
A back that is stiff in the morning and loosens up over the course of the day behaves differently from one that gets steadily worse after eight hours at a desk. Different conclusions follow from each. Two or three entries on typical days - morning, after work and before sleep, say - make that pattern clearly visible within a few weeks.
Movement is both a factor and a treatment
Because movement can be both trigger and treatment, it is worth separating it cleanly:
- What was it? A walk, physiotherapy, gardening, sport, carrying something.
- When was it? Before or after the entry.
- What followed? Worse immediately afterwards, better the next morning - this delayed pattern is typical and is almost always misremembered without notes.
In PainTrack you cover this with the tags for the circumstances: active, rested, stressed, slept badly, cold, warm. What exactly you did belongs in the free-text note - ideally in a fixed wording such as "physio 45 min, better for 2 hours afterwards". Consistent phrasing is far easier to scan later than freely worded sentences.
Record several regions separately
Combining the neck and the lower back into a single value produces a curve that represents neither complaint correctly. Separate pain definitions with their own colours are better - then the chart shows you whether both really are increasing or only one region.
The free version of PainTrack includes one active pain definition. If you have to choose, take the region that troubles you most. With Pro you create as many as you like and see several trends together in one chart.
What this becomes at your appointment
After four to six weeks you have figures that carry weight immediately:
- Days affected: "Symptoms on 22 of 30 days."
- Average severity and range: "An average of 5, an 8 on four days."
- Pattern: "Almost always after long periods of sitting, clearly better in the morning."
- Effect: "Since physiotherapy started three weeks ago, two to three more good days per week."
- Impact on daily life: "Three working days lost, sleep disturbed on six nights."
With PainTrack Pro you turn that into a PDF doctor's report for a freely chosen period, optionally with charts. To see what that looks like, have a look at the sample report as a PDF. How to prepare for the appointment beyond that is covered in Preparing for a pain appointment.
When not to wait for your next appointment
A diary documents the trend - it does not replace an examination. Among other things, you should see a doctor promptly if you have numbness or loss of strength in a leg, problems with bladder or bowel function, numbness in the saddle area, back pain with a fever, pain after a fall or accident, or severe pain that occurs at night at rest or comes with unexplained weight loss.
Frequently asked questions
How long should I keep a diary for back pain? At least four weeks without a break, so that weekly rhythms become visible. To judge the effect of a treatment, two to three months makes more sense - ideally starting four weeks before it begins.
Do I need to log something on good days too? Yes. Without symptom-free days you can neither state the number of affected days nor judge whether a measure is working.
How many times a day should I log an entry? Once a day is enough as a basis. On typical days, two to three entries are helpful because they show the course of the day.
Should I record the neck and lower back together? Better separately. Combined, two different courses average into one curve from which nothing can be concluded.
Will my doctor take the diary seriously at all? Records are established practice in pain documentation and are explicitly recommended. It helps not to bring the pile of raw data but the three or four summarising figures - with the rest available alongside as evidence.
PainTrack is not a medical device and does not replace medical diagnosis or treatment. The app is intended for personal documentation and self-observation.