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Marshall James Nev, PLC | Keeping a Daily Pain Diary in Richmond

Lexington-Richmond Headache Clinic
Marshall James Ney, DMD, FAAOP
Fellow American Academy of Oral Facial Pain

527 W. Main St.
Richmond, 40475
(859) 623-3761

Keeping a Daily Pain Diary


Management of anything requires record keeping, thinking and understanding. Management of headache and neck pain is no different. This is why it is critical that you keep a daily pain diary when you first begin our program.

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A good diary can help manage your pain in several ways. First, it allows your doctor and you to evaluate your pain and progress, and regulate your medicine and activities. Second, it forces you to write down the necessary facts that may help you deal with your pain. Writing these facts down makes you think about what you may be doing right —or wrong! A good diary should be easy to read for both the doctor and the CEO of pain management: YOU.

Your diary should include:

Pain Information:

  1. Location
  2. Duration
  3. Intensity (highest level of pain that day, say on a scale from 1 to 10, where 10 is the highest)
  4. Type of pain
    • Fast throbbing (vascular/migraine)
    • Steady, constant, or slowly throbbing (muscle)
    • Burning or electric-like (actual pain in the nerve itself)

Sleep Information:

  1. Times you took your sleeping medication
  2. Times to bed
  3. Times you woke up
  4. Number of times you woke up during the night
  5. Did you dream (a little) (some) (a lot)?
  6. Stress: Was it a particularly stressful day? (use a 1 to 10 scale, for example, where 10 is the most stressful)

Medication Information (only the medication we prescribed)

  1. Sleeping Medication?
  2. Anti inflammatory medication?
  3. Other medication?

Keep your diary daily. Do not try to remember from week to week or even do 2-3 days at one time. You cannot remember accurately. Bring your diary with you for follow up visits.

The diary contains answers to what causes your headache/neck pain. Each of us treating you needs to be aware of your progress. The reward for keeping a good diary and complying with all aspects of the program is a quicker, faster and less expensive recovery!

Yes, less expensive. We are not in the greatest recovery economic period and all of us have to watch what we spend. Any medical problem can be expensive. We actually want you to get pain free as cheaply (money wise) as possible. This is true whether you have or don't have insurance. Please note that we have a special "Help for Help" Program that can reduce your headache treatment costs even further.

One of the ways we can manage your pain efficiently is for you to email your daily diary entries to Dr. Ney.

We don’t want to make you take off work, drive to the headache clinie, fill out the follow-up forms, and wait to see Dr. Ney to tell you, for example, to go up 10 mg of your sleeping medication. That would be an unnecessary money and time expense altogether.

If you keep up your daily diary and email him the entries, Dr. Ney will email you what he thinks you should do.

Periodically, however, we do need to have a face to face meeting…something with some eye to eye contact. Don't worry about it. Remember, Dr. Ney was once in the same boat that you were in because he suffered a constant headache for 7 years. So, fess up if you have not adhered to the suggestions; just tell him what you have done and what you have not done.

The goal is very simple ... to manage your pain, so you, your spouse, your children, and your friends can have a better relationship with you. No relationship can prosper if you are in pain!

It is clear that managing your pain is not just imperative, it is critical! It is not just critical for your life, but also for your family and friends. You play an unbelievable role in all of the above relationships. You cannot do it when you are in pain. It is just not possible.

Think about it. Whether it is a night out, taking the children to the park, or some other occasion, how many times have you said “not tonight honey, I have a headache"? Our goal is to eliminate this excuse so you can have an experience that will help all your relationships.

Here is a typical diary entry for Dr. Ney, before he knew what caused his headaches:

  • Morning - awaken, but tired; not feeling refreshed
  • Mid morning - felt a pressure in my temple and neck
  • Lunch - eating was a distraction, but the pressure that I felt in the mid morning, was starting to turn into pain
  • Mid afternoon (3:00 PM) - the pressure had turned into pain, 5 on a scale of 10. Took ibuprofen, Tylenol, caffeine, which did reduce the pain for a while, but when I arrived at the house, Betsy was ready to hand over the boys to me, and I just wanted to go to the bedroom and curl up in fetal position to sleep the pain off.

To be very blunt, this type of life sucks. Every one blames you and there are no tests or scans or MRI’s that can corroborate the test results with your pain. On your next visit to the doctor, if you are suffering headaches such as above, the doctor might say "You just have too much stress in your life and you need to deal with it." We say, this is just not a solution.

Instead, we want to look comprehensibly at your headache/neck pain, and see what we can do to remove the pain. Our goal is to see you with the least amount of medication and the most knowledge about headache/neck pain so that you can manage your own pain.

We are not saying not to go to a chiropracter. Our goal is to have you in our office the least number of times to manage your pain. We just want you to get better with as little pain trauma and cost to you as possible.

We hope email can keep us apprised of most of your problems initially. However, complications may arise that may necessitate a face to face visit. When you do visit the headache clinic office, o be efficient, do please bring your diary.

If we do need to keep you on medication, we will need to see you at least two times per year.


Richmond Dentist | Keeping a Daily Pain Diary. Marshall James Ney is a Richmond Dentist.