Pain assessment using OPQRST

OPQRST – This little string of the alphabet helps you to do a comprehensive pain assessment. Obviously if someone has pain from a cut finger, you deal with the finger. When you need to dig more deeply and find out more about a painful condition, the OPQRST pain assessment method will help. As far as you can, ask the questions as part of a normal, conversational assessment. Try to avoid interrogation! So let’s start with what OPQRST stands for before we dig in more deeply:

• Onset
• Provoking
• Quality
• Radiating
• Severity
• Time

Onset

The first part of your pain assessment. You may want to ask/consider these topics. (Remember to keep it conversational, you might not be asking these in order!)

• What were they doing when it started?
• Did it come on at rest or while working/stressed?
• What do they believe causes the pain?
• Was it sudden?
• Did it come on gradually?
• Is it something they already have and part of a known condition?

Provoking

• What makes it worse?
• And in fact, what makes it better?
• Any movement making it worse?
• What about when you press on it?
• What about moving related areas? (Eg: moving an arm may hurt a shoulder)

Quality

Ask them to describe the pain. Try to ask them and not lead them: “Tell me what it feels like” is better than “Is it stabbing? Burning? Throbbing?” Let them give you the description. Is there a pattern to it? Eg: When I walk/sit/stand/move; every X minutes, hours, days, etc.

Radiating (or region)

• Is it just one specific area or does it radiate (spread).
• If so, where does it spread.
• Just one area or several.
• Is there any referred pain (pain in a seemingly uninjured or unconnected place).
• Does the pain seem to move around?

Severity

Ask them at first how bad it is, then try to put that into perspective. Often pain scales can be used (eg: from one to five – how bad is it?). These are somewhat useful, but limited in most people depending on their experience of pain. Has it happened before and if so, is it worse pain or lesser? During your pain assessment remember there are people whose pain is always 5/5 no matter what. As always, your judgement comes in to this as well.

Time

• When did it happen?
• How long has it been going on?
• Has it happened before – when?
• How long since the pain was at its worst/lowest point?
• How long since it seemed to improve/worsen?
• How long since it stopped hurting?
• How long did it feel sharp/burning/whatever before it became dull/achy/throbbing/whatever?

And that’s it – simple, kind of…. OPQRST is an easy way to help you recall the kinds of questions you should be asking, but always use your won judgement. It’s unlikely you’ll need (or want) to ask all those questions on one patient assessment.
 
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