What is the PQRST Pain Scale?

If you are in nursing school, you have undoubtedly heard of this comprehensive pain assessment tool.

Known as the PQRST pain assessment method, this technique uses a mnemonic to help remember the important aspects of pain assessment.

It allows your patient to describe their pain in a structured and detailed manner, giving you a comprehensive picture of what they’re experiencing. This method can help you create a more accurate and tailored treatment plan.

Important note:

This pain assessment method works well for people who are not cognitively impaired or have dementia and can communicate their pain to you.

For Dementia patients, the PAINAD scale is a better option. Click the link to learn more about it. I have also included a PDF of that pain scale that you can download.

What does PQRST stand for?

The PQRST mnemonic stands for:

P = Provocation or Palliation: Helps figure out what factors cause or alleviate the pain they are experiencing.

Q = Quality or Quantity:  Refers to the nature and intensity of the pain.

R = Region or Radiation: Involves identifying where the pain is and if it spreads to other areas.

S = Severity: Asks patients to rate the intensity or severity of pain on a scale of 0 to 10.

T = Timing: Involves understanding when the pain started and if it is constant or intermittent.

When to use PQRST?

So, when to use PQRST? You can employ this method during any assessment of pain, whether it’s light or severe or acute or chronic, regardless of the patient’s age or condition.

Essentially, whenever a patient reports discomfort, it’s time to use this tool.

Healthcare providers use the PQRST assessment tool because it promotes better communication between patient and provider, leading to more effective care and better outcomes.

What to ask a patient during the PQRST Pain Assessment

When using this method, the goal is to understand not only the cause and types of pain but also its severity, location, timing, and factors that aggravate or alleviate it.

Remember, you’re not just there to ask the patient questions; you’re building a comprehensive picture of your patient’s pain experience.

Let’s go back to our mnemonic to put this into clinical and practical context:

(P) Provocation or Palliation: 

• What were you doing when the pain started?
• What provokes the pain, and what, if anything, makes it better or worse?
• What do you think is the cause of the pain? (Triggers, stress, Certain positions?)
• What makes it better? (Heat, massage, rest, exercise, rest, walking, lying down?)
• What worsens it? (Moving, certain positions, certain activities, standing, sitting?)

(Q) Quality: 

• Can you accurately describe the pain? (Is it sharp, dull, stabbing, burning, throbbing, or crushing?)

(R) Region or Radiation: 

• Where do you feel pain, and does it spread to other areas?
• Which areas does it radiate to?
• Does it stop somewhere?

(S) Severity Scale:

• On a scale of 0 to 10, with 0 being no pain and 10 being the worst pain imaginable, how would you rate your pain?
• Does the pain interfere with your quality of life or daily activities?
• Does it force you to change positions or slow down?

(T) Timing:

• When does the pain begin? (Time of day)
• Does the pain come on suddenly or over time?
• How long has the pain been present?
• Does the pain come and go, or is it constant?
• How often do you have these pain episodes (daily, once or twice a week, etc)
• Is the pain severe enough to wake you up from sleep or a nap?
• Does the pain come before, during, or after any meals?
• Does anything else happen after the pain comes? (Nausea, bleeding, dizziness, etc)

How to Document the PQRST Pain Assessment

Once you’ve gathered this insightful information, it’s essential to document it correctly and thoroughly in your patient’s medical chart.

Remember, pain is subjective and can vary greatly from one person to another:

• Jot down the specific answers to each of the PQRST questions, making sure to note your patient’s own words whenever possible.
• Did the patient understand how to rate their pain using the 0-10 pain scale?
• Is the treatment modality working? Has the pain score decreased after treatment? By how much per patient report?
• When did you reassess your patient’s pain after treatment? Was it timely?
• Did you communicate your patient’s response or non-response accurately to the physician? In a timely fashion?
• Did you educate your patient about what to expect and how to communicate to you about their response to treatment?

The video below provides a very nice overview of the PQRST Pain Assessment Method:

Important note: the video calls the method “OPQRST”, where the “O” stands for “Onset.”

It is exactly the same as the PQRST method. In this video, they have merely taken the onset of pain out of the “Timing” part of the mnemonic. I prefer to lump it together with “T.” It makes more sense to me. 

Frequently Asked Questions

How valid is the PQRST Pain Assessment Method compared to other pain assessment scales?

The PQRST pain assessment method is generally considered valid and effective compared to other scales. However, its effectiveness can vary depending on the individual’s ability to report symptoms accurately.

Are there any limitations or potential challenges when using the PQRST Pain Assessment Method?

Yes, there are limitations to the PQRST method. It relies heavily on patient’s self-report, which can be influenced by subjective factors. Also, it may not be as effective for nonverbal or cognitively impaired patients.

Can the PQRST Pain Assessment be used for all age groups, including children and the elderly?

Yes, the PQRST pain assessment can be used for all age groups. However, children may find it difficult to articulate their symptoms and the elderly may have memory issues, requiring careful and patient assessment.

How can the PQRST method be adapted for patients who are unable to communicate verbally?

For non-verbal patients, adapt the PQRST method by observing behavioral signs of pain. Note changes in body language, facial expressions, or agitation levels. Use pain scales suitable for their cognitive and communication abilities.

Is the PQRST Pain Assessment Method applicable in scenarios where the patient’s pain is chronic or ongoing?

Yes, the PQRST method can certainly be applied for chronic or ongoing pain. It helps identify patterns, triggers, and relief measures, making it a valuable tool for managing long-term pain conditions effectively.