You started physical therapy three weeks ago, or a new medication. At your next appointment your doctor asks: "Has it helped?" You answer "I think so, a bit", and on that basis the two of you decide whether to continue. A diary answers the question "is my pain treatment working?" more reliably than memory.
You need a baseline before the start and a period of the same length afterwards. Add notes on your daily life, because a treatment can work without the number on the scale dropping much. The basics are in the guide to keeping a pain diary.
Memory distorts the comparison
Three traps make looking back unreliable:
- Recent days count double. Before the appointment you mainly remember the worst days and the last week. Three good weeks before that fade.
- Return to the average. You usually start a treatment when things are at their worst. Pain fluctuates, and better weeks often follow a low point, with or without treatment. Without a baseline you credit that improvement to the therapy.
- Several changes at once. New tablets, two weeks of vacation and less overtime: afterwards you can't tell which one made the difference.
Written records defuse all three traps, as long as you measure the same way before and after the start.
The baseline before you start
Start the diary as soon as the treatment is agreed. Two weeks of baseline is a workable minimum; with four weeks you also see swings within a month.
Keep the measuring rules the same throughout:
- The same scale, usually 0 to 10. The article on the pain scale from 0 to 10 explains how to get comparable scores.
- The same time of day, for example every evening at 8 pm.
- The same frequency. If you log once a day before and three times a day after, you are comparing two different things.
Also note what you already do for the pain, such as heat, movement or an as-needed medication. If that changes after the start, it belongs in the comparison.
If treatment has already begun, ask when an effect can be expected. Use the days up to that point as your baseline, even though they fall after the start.
Compare intensity and function
The research initiative IMMPACT recommends that chronic pain trials measure physical function, emotional functioning and the patient's own rating of change alongside pain intensity. For your diary that means:
| Measure | Example |
|---|---|
| Average intensity | Mean per period on the 0 to 10 scale |
| Pain-free days | Number of days at 0 |
| Function | "walked 20 minutes", "stairs without a break", "full workday" |
| Sleep | slept through, yes or no |
| As-needed medication | Days with a dose |
| Side effects | Tiredness, nausea or dizziness as a note |
Pick one or two function goals you miss in daily life and record them the same way every day. You can count "carried the groceries myself" after four weeks. You can't count "so-so".
For orientation from research: in an analysis by Farrar and colleagues (journal Pain, 2001), a drop of about two points or 30 percent on the 0 to 10 scale matched what patients described as much improved. That is no target for you. A smaller drop can mean a lot if you sleep through the night or can work again.
Checklist for the comparison
Say you start physical therapy on March 1. You compare the four weeks before March 1 with four weeks after. This checklist keeps the comparison fair:
- [ ] Both periods are the same length.
- [ ] You logged on a similar number of days in each.
- [ ] Every other major change has its own date in the diary.
- [ ] You noted outliers such as an infection or a move instead of deleting them.
- [ ] Besides the average, you compare your function goals.
If the difference turns out small, keep logging and compare again after another month before you reach a verdict.
How PainTrack handles this
In the free version you add an event of the kind "Started therapy" or "Changed medication", with a label such as "PT twice a week". It appears as a dashed vertical line in the History chart. The Weekly trend card compares the last seven days with the previous week and with the week four weeks ago. For as-needed medications, the "Follow-up on the effect" asks after 1, 2 or 4 hours how you feel. You track function goals as your own tag, such as "stairs without a break".
With PainTrack Pro, the "Events" view of the "Insights" card runs the before/after comparison: up to 28 days before the event against up to 28 days after. Each side needs at least 14 days and 3 entries on 3 different days. A neighbouring event shortens the window, and the app states the length it compared. Effect over time shows your intensity before and after doses of a medication. The PDF doctor's report lists events with their before/after comparison, as in the example report. For the appointment itself, see preparing for a pain appointment.
When not to wait for the numbers
Contact your doctor promptly if you notice new or severe side effects, clearly worse pain, or new symptoms such as numbness, weakness or fever. Don't stop a medication or change a dose on your own, even if your review shows no effect. Discuss the result with your doctor.
Frequently asked questions
How long does it take for a pain treatment to work? That depends on the treatment and ranges from hours to weeks. Ask at the start when an effect can be expected, and set your comparison period accordingly.
What if I don't have a baseline? Start logging today. Old notes, your calendar or sick notes give you rough clues about the time before. At the next change, such as a new dose, you will have a baseline, and until then you compare later months with each other.
When is a pain treatment considered effective? There is no fixed threshold for you. Studies often use a 30 percent reduction as a guide. Whether you manage more in daily life counts too, and you make that call together with your doctor.
Can I assess two treatments at the same time? If both start on the same day, you can't separate their shares. Create a separate event for each change and ask your doctor whether a staggered start is possible.
PainTrack is not a medical device and does not replace medical diagnosis or treatment. The app is intended for personal documentation and self-observation.