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Pain Assessment - SOCRATES for chest pain

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You can use it to gather information about the patient's symptoms and level of pain. It can help you devise an effective pain management plan and start much-needed treatment immediately.

In this post, we'll explain how to use the PQRST mnemonic to assess pain effectively during a first aid response.

At firstaidforfree.com we love our first aid mnemonics and we've tried to compile a list of the best first aid mnemonics around.

What Does PQRST Stand For?

PQRST is a pain assessment method that stands for:

Provocation

Now, let's take a closer look at each factor.

Provocation or Palliation

If you can determine the reasons that aggravate the pain, then perhaps, the source of pain can be pinpointed more accurately. Ask the patient what they were doing when the pain first started, what the triggers are, and if certain activities or positions that worsen the pain.

A patient may feel pain for obvious reasons, such as a medical condition or a physical injury. When the cause of pain is unknown, the first thing to investigate is what provokes it.

Your goal is to determine whether certain activities, movements, and positions worsen the pain. Consider asking these questions:

Do specific actions or movements aggravate pain? (e.g., standing, walking, stretching, laughing, coughing, deep breathing, etc.)

Does external pressure worsen or relieve the pain?

Is the pain worse or relieved in certain positions? (e.g., sitting, standing, lying flat, lying on the side, etc.)

In addition, you want to know if the patient has made initial attempts at pain relief.

Have you tried any at-home treatment to ease the pain? (e.g., hot or cold compress, massage, herbal oils, etc.) Did it work?

Quality

Since pain is quite a broad term, it is imperative that you ask the casualty to describe the pain. Provide them with words such as dull, sharp, twisting, shooting, crushing, burning, or throbbing.

For example, if they have chest pain, it could point to a cardiac condition, and if they feel pain in their nerves, it will probably be more focused and sharper.

Ask the patient to describe their pain. If the patient cannot explain their symptom, offer these adjectives:

Region or Radiation

The region of the pain can help you further understand the patient's condition. There can be two types of pain, namely radiating pain and referred pain.

Radiating pain keeps spreading from the pain's point of origin. An example of this is when one's sciatic nerve gets pinched.

Referred pain is when someone experiences pain in a location that is different from the actual source of the issue. The most common example is the ' brain freeze' we might experience on having ice cream.

So, ask them where the pain is located and if it radiates. It is also vital to find out if they feel like it has been traveling around or if they feel it started at one point and is now localized at a different spot.

The location of the pain narrows down the conditions the patient may have. Another clue is radiating pain, where pain spreads into a broader area of the body.

For example, cardiac chest pain can radiate to the arms, back, and jaw.

Here are some guide questions to keep in mind:

Where do you feel the pain?

Is it confined to just one part?

Does it travel or spread to other areas?

Did it start in one spot and is now in another place?

Note: you can ask the patient to point to the location of the pain.

Severity

Merely describing the severity of one's pain is not enough, which is why it's crucial to ask the patient to rate their pain between 1 to 10.

Ask them the following questions as well:

How bad is the pain when it's at its worst?

Does the pain interfere with any other activities?

How long does every episode last?

Does it force you to lie down or slow down or sit down?

Timing

'T' stands for timing as well as triggers. The questions in this category include:

When or at what time did the pain begin?

Is the pain gradual or sudden?

How often does the pain occur?

How long does the pain last?

At what time of the day do you usually experience pain?

Does the pain ever wake you up?

Has the pain ever led to anything else?

Do you feel the pain before, after, or during your meals?

When to Use PQRST?

You can use the PQRST mnemonic in emergencies where a patient reports pain, such as:

Acute pain: sudden and short-lived pain resulting from an injury or surgery

Chronic pain: persistent pain lasting for over three months.

Nociceptive pain: pain caused by injuries to tissues, such as a wound or broken bone

Neuropathic pain: pain caused by damage or injury to the nervous system

Referred pain: pain felt in a different location from its source

Somatic pain: pain felt in the skin, joints, bones, and muscles.

Visceral pain: pain felt from internal organs

Example Situations

The PQRST mnemonic can be effective in documenting chest pain. Check out this example:

Provocation: The pain started after climbing a flight of stairs. It gets worse with activity.

Quality: The pain is crushing.

Radiation: The pain is on the left side of the chest and spreads to the neck, back, and shoulders.

Severity: The pain is an 8 out of 10.

Timing: The pain lasts several minutes, goes away, and returns.

This example uses the PQRST mnemonic to assess abdominal pain:

Provocation: The pain started after eating a large meal. It worsens when coughing or laughing.

Quality: The pain is a constant dull ache.

Radiation: The pain radiates to the back.

Severity: The pain is a 6 out of 10.

Timing: The pain has been present for an hour and has not improved.

In each of these situations, the first-aider quickly gathers vital information about the patient's pain that can help guide treatment.

Other Questions to Ask for Further Assessment

Here are a few more questions to ask a patient to evaluate their pain:

Do you have any symptoms aside from pain?

Are you taking any medications?

Do you have any allergies?

Do you have any history of recurrent pain?

Did you have a recent accident or surgery?

FAQs

Final Thoughts

In conclusion, the PQRST mnemonic is a systematic approach to understanding a patient's pain. This method can help the first-aid provider capture crucial details about the symptom quickly and accurately, facilitating intervention

Want to learn more about first aid? Why not take one of our free online first aid courses! No registration or certificate fees.

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PQRST Pain Assessment Method - First Aid for Free

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The PQRST mnemonic is a valuable tool for pain assessment when responding to medical emergencies. What does PQRST stand for in first aid?

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The PQRST mnemonic. Where P stands for provokes. What provoked the pain? What makes it worse? What makes it better? Did the pain occur at rest or during exertion? Did the pain wake the patient up? Q for quality. This could be sharp, dull, squeezing, a slight pressure, a burning or aching pain, a pounding pain, colic-like or cramping, or a stabbing pain. R for radiates. Does the pain move anywhere? Ask the patient to point to anywhere they feel pain. S for severity. Ask the patient to rate the pain on a scale of 0 to 10. Where 0 is no pain, and 10 is the worst pain imaginable. T for time. Ask the patient: when did it start? Was the onset slow or sudden? How long has it lasted? Is it a constant or intermittent pain? Does it come and go? Have you had the pain previously? Is it the same as previously or is it different from last time? Remember to document all your observations.

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The PQRST mnemonic. Where P stands for provokes. What provoked the pain? What makes it worse? What makes it better? Did the pain occur at rest or during exertion? Did the pain wake the patient up? Q for quality.

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Important: The authors, reviewers, and editors of this material have made extensive efforts to ensure that treatments, drugs, and discussions about medical practice are accurate and conform to the standards accepted at the time of publication. However, constant changes in information resulting from continuing research and clinical experience, reasonable differences in opinions among authorities, unique aspects of individual clinical situations, and the possibility of human error in preparing such an extensive text mean that other sources of medical information may differ from the information on this site. The information on this site is not intended to be professional advice and is not intended to replace personal consultation with a qualified physician, pharmacist, or other health care professional. The reader should not disregard medical advice or delay seeking it because of something found on this site.

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Important: The authors, reviewers, and editors of this material have made extensive efforts to ensure that treatments, drugs, and discussions about medical practice are accurate and conform to the standards accepted at the time of publication.

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In order to understand how the disease process associated with heart disease, it is important to consider how the healthy heart is structured and how it works.

The heart is separated into left and right sides by a muscular band called the septum.

On each side of the heart there are two chambers; an atrium and a ventricle with a valve separating them.

These chambers collect blood, and the valves keep it moving in the correct direction through your heart. The heart muscle squeezes to pump blood around your body.

It can be useful to think of the working of the heart involving the following 3 systems:

The pumping system

The electrical system

The plumbing system

The pumping system

The heart is a muscle that pumps blood around the body through blood vessels. The myocardium is the middle layer of the heart wall. Arteries carry oxygen rich blood away from the heart. Veins carry oxygen-poor blood towards the heart. Capillaries are tiny vessels which connect arteries to veins.

Examples of conditions involving the pumping system include: heart failure, cardiomyopathy.
Learn about Heart Failure
The electrical system

The heart's pumping action is regulated by an electrical conduction system that coordinates the contraction of the chambers of the heart. These electrical impulses cause the atria (upper chambers of the heart) to contract a fraction of a second before the ventricles (lower chambers of the heart) so their blood empties into the ventricles before the ventricles contract and pump blood out of the heart. The electrical system of the heart ensures you maintain a normal heart rhythm.

Examples of conditions involving the electrical system include: atrial fibrillation, heart block.
Learn about Atrial Fibrillation
The plumbing system

Like all muscles, the heart needs a good blood supply to ensure it can work effectively and pump blood around the body. The coronary arteries extend over the surface of the heart to take oxygenated blood to the heart muscle.

Examples of conditions involving the plumbing system include: atherosclerosis, high cholesterol.
Learn about Cholesterol
Cardiovascular disease refers to all diseases of the heart and circulation, can involve any of the systems described above, and is one of the leading causes of death and disability in Ireland and worldwide.
Click here to learn more about Heart Disease Click here to view our upcoming complimentary education sessions
Written by James Murray, Cardiac Physiotherapist.
Book a consultation

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In order to understand how the disease process associated with heart disease, it is important to consider how the healthy heart is structured and how it works. The heart is separated into left and right sides by a muscular band called the septum. On each side of the heart there are two chambers; an ...