Could your pain diary be making you feel worse?
If you’ve seen a doctor for headache or migraine, you’ve almost certainly been told to keep a headache diary or journal. Some doctors will tell you just to write down the pain level, while others instruct you to include every little detail—pain level, duration, symptoms, possible triggers, meds taken…. Still, few of us actually take this advice. A recently published study says maybe we have the right idea.
A study on pain diary use in patients who had short-term lower back pain found that those who kept diaries had a “much worse outcome,” according to the study’s lead researcher, Robert Ferrari, MD. At the start of the study, all 58 participants had the same level of disability due to the pain. Half were told to keep a journal of their daily pain levels on a scale of 1-10. The other half were given no such instruction. Of the participants who kept diaries, 52% reported recovery after three months. Of those who didn’t keep diaries, 79% reported recover in three months. Patients who were in the pain diary group, but didn’t keep up with the diary, reported levels of recovery at the same level as those who did not keep diaries.
Dr. Ferrari believes that asking patients to focus too much on their symptoms magnifies the symptoms, creating a perception of greater severity, and, ultimately, preventing recovery. "It's just more evidence suggesting that how we think about our symptoms affects our symptoms. Symptoms are everything when it comes to the sense of recovery," said Dr. Ferrari.
The findings of this study may be directly comparable to simple headaches, but not to migraine and some other headache disorders, which typically have other substantial symptoms beyond pain. In the case of migraine, diaries usually include more than pain levels and can be tremendously useful for finding triggers and premonitory symptoms. Still, if you suspect that keeping a diary makes you feel worse, backing off for a while might yield good results.
REFERENCES
Ferrari, R. (2015). Effect of a pain diary use on recovery from acute low back (lumbar) sprain. Rheumatology International, 35(1), 55-59.
Neitz, R. (2015). UAlberta clinical professor shows pain diaries may slow patient recovery. University of Alberta Press Release.
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