Pain Assessment PQRST – It’s Not a Typo

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PQRST may look like a page taken from your preschooler’s text, or maybe even a typo at first glance, but it is in fact a mnemonic to help first aid administrators or medical practitioners diagnose pain. The pain assessment PQRST method is a 5-part set of questions designed to facilitate analysis of a patient’s symptoms and history, which aids in determining an appropriate course of treatment. Occasionally, the mnemonic will includes an initial “O” for “Onset” to help the patient qualify his/her behavior when the pain started – whether he/she was active, inactive, or stressed. The “O” also helps medical staff understand if an activity prompted the pain or if the pain was sudden, gradual, or chronic.

The “P” in PQRST stands for “Provocation” or “Palliation.” Doctors or nurses ask the patient questions regarding what may have provoked onset of pain and whether any movement, pressure, or other external factor intensifies or lessens the pain. This step helps medical staff to identify what conditions or activities makes the discomfort better or worse.

The “Q” in the pain assessment PQRST method represents “Quality” of the pain. Open ended or leading questions are typically used to encourage the patient to describe the pain. Adjectives such as sharp, dull, burning, stabbing, tearing, pulsating, and radiating are among the descriptors that medical practitioners employ to help the patient draw out what the pain feels like. Additional questions probing the patient about the pattern of the pain, e.g. intermittent, constant, or throbbing, are also asked during this stage.

The “R” in this useful mnemonic tool stands for “Region” or “Radiation”. This set of questions is designed to evoke answers about whether the pain radiates from the onset location or if it has spread to other areas of the body. Determining whether the pain is localized or extensive can help give attending staff clues regarding underlying conditions and medical causes for the aggravation.

The “S” is measures the “Severity” of the pain and is usually gauged on a scale of 0 to 10, 10 being the worst possible pain.  In asking questions about the severity of the pain, the prompts can be comparative (“…compared to the worst pain you have ever experienced”) or imaginary (“…compared to having your foot ran over by a car”).  If the question is a comparative one, additional queries about the nature of the event can help flesh out details about the patient’s description of the severity of the pain. Asking additional question about the previous event used as a comparison can allow the clinician to assess whether the score is realistic or exaggerated.  If the patient cannot vocalize the pain, then nonverbal methods such as the Wong-Baker Faces Pain Scale can be employed to diagnose severity.

The final set of questions in “T” assesses time. These questions get to the root of the history of the problem – when it started and how long the pain has persisted. “T” questions can also gauge whether and how pain may have changed since the onset or when the pain stopped.

All articles, tips, and stories within the NPC Community are written by individual writers and members. No content, recommendations, or information is meant to be taken as medical advice, which can only be obtained from a medical professional. Please consult with a doctor about any of your medical questions and needs.