Dear Diary...My Pain Feels Worse

Keeping diaries to report symptoms and signs of change for patients with certain medical illness, especially those associated with pain, has been encouraged by some health organizations and physicians as well, but a news study reveals that doing so may sometimes make symptom perception worse.

The study is titled “Effect of a Symptom Diary on Symptom Frequency and Intensity in Healthy Subjects” and is published in the Journal of Rheumatology.

Researchers from the Department of Medicine and the Department of Rheumatic Diseases, University of Alberta, in Canada, sought to evaluate how keeping such logs may or may not affect the way patients experience with chronic pain conditions experience their symptoms.

To find out, the team randomly assigned subjects to two groups. One group of 18 subjects kept a daily diary and the other group of 17 subjects served as the control. Subjects in both groups were asked to complete an initial symptom checklist. The checklist included symptoms such as headache, neck pain, back pain, fatigue, abdominal pain, elbow pain, jaw pain, and numbness/tingling in the arms or legs. Each group was also asked to indicate their symptom frequency and their “perceived average symptom severity in the last 14 days.”

Next, the subjects in the diary group were asked to examine the symptom checklist for the next 14 days, but the control group was not. Two weeks later, both groups were asked to repeat the symptom checklist “for recall of symptoms and symptom severity.”

The researchers found that at the start of the study, both groups reported similar frequencies and intensities of symptoms.” However, after the two week interval, in which one group used a diary and the control did not, the diary group showed “an increased frequency of recalled symptoms” and a significantly increased intensity of symptoms compared with the control group. The diary groups increase in frequency of recalled events compared to the control group was double. The control group did not change from its initial mean scores.

The researchers concluded that “The use of a symptom diary for 2 weeks, even in generally healthy subjects, results in increased recall of daily symptoms and increased perception of symptom severity.”

The results may be something to consider when examining a chronic pain patient’s symptom diary, although many health professionals and studies seem to suggest diaries are an important tool.

There are currently a number of heatlh websites for consumers that feature pain diary tools and articles that advocate their use in managing chronic pain syndromes. For example, an article on Health.com, titled “Why it’s Important to Keep a Pain Diary” suggests that such tools can help provide a patient’s physician with “detailed data to plot out the causes and triggers of [his or her] chronic pain and build a treatment plan.”

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Will these study results affect how you interpret you patients' diary entries? Leave a comment.