Free template · PDF · US Letter
Free Printable Nerve Pain Diary (PDF)
| Date & time | Location | Type of sensation | Severity (0–10) | Duration | Activity / trigger | Medication taken |
|---|---|---|---|---|---|---|
How to use this sheet
- Print the PDF and keep it accessible — near your medications or in the room where episodes most often occur.
- When an episode starts, log the date, time, and location as soon as you can — memory of onset details fades quickly.
- Circle or write the type of sensation: burning, shooting, pins-and-needles, numbness, or weakness.
- Rate severity (0–10) and note how long it lasted once it subsides.
- Write what you were doing when it started or what seemed to make it worse. Bring the completed diary to your neurologist.
Questions
Is this diary really free?
Yes. The PDF is free to download and print — no sign-up, no email.
What types of neuropathy is this diary useful for?
Any peripheral neuropathy — diabetic, idiopathic, Charcot-Marie-Tooth, chemotherapy-induced, or otherwise. The sheet tracks symptoms rather than cause, so it works regardless of the underlying diagnosis.
Should I track every sensation or only severe ones?
That's your call, but most neurologists prefer more data over less. Even mild episodes that don't interrupt your day can reveal a pattern — especially if they cluster around a specific time, activity, or medication schedule.
Is there an app version?
Yes — NerveLog for iPhone logs neuropathy symptoms, location, and factors and shows which patterns emerge over time. Core is free, no account needed, data stays on your device.
Want the log to analyze itself?
NerveLog for iPhone tracks the same things in seconds and shows you the patterns — free core, no account, and everything stays on your device.