Post Procedure Pain Diary - to be completed after your procedure

First Name

Last Name

Procedure

Date

List activities that normally make your pain worse: (e.g. bending/standing/neck movement)

Pain before procedure (Doctor to complete)

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Pain 1 hour after procedure

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Pain 2 hours after procedure

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Pain 3 hours after procedure

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Pain 4 hours after procedure

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Pain 6 hours after procedure

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Pain 8 hours after procedure

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Pain morning after procedure

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Patient Notes