Understanding a patient’s pain, monitoring their pain level and taking actions to reduce a patient’s pain is an important responsibility for healthcare providers. Assessing a patient’s pain is more than subjectively observing the patient to be in pain or lacking obvious signs of pain, like crying or agitation. To better understand a patient’s pain rating, including the pain severity, healthcare providers ask the questions using the OPQRST acronym.
What is OPQRST?
OPQRST is a useful patient assessment mnemonic or memory device used by EMTs, paramedics, as well as nurses, medical assistants and other allied health professionals to learn about their patient’s pain complaint. OPQRST is a conversation starter between you, the pain investigator, and the patient, your research subject.
OPQRST stands for:
- Onset
- Provokes or paliates
- Quality
- Radiates
- Severity
- Time
What are the OPQRST questions?
The OPQRST questions should be the start of a conversation between the healthcare provider and the patient. Don’t limit yourself to a single question per letter. Instead, be an investigator and ask follow-up and probing questions to better understand the patient’s pain complaint.
Here are some suggestions on how to approach using OPQRST as a patient assessment tool:
Onset
“Did your pain start suddenly or gradually get worse and worse?” This is also a chance to ask, “What were you doing when the pain started?”
Provokes or Palliates
Instead of asking, “What provokes your pain?” use real, conversational words. Try, “What makes your pain better or worse?”
Quality
Asking, “Is your pain sharp or dull?” limits your patient to two choices, when their pain might not be either. Instead, ask, “What words would you use to describe your pain?” or “What does your pain feel like?”
Radiates
This is another chance to use real, conversational words during the assessment. Asking, “Does your pain radiate?” sounds silly and pompous to the patient. Instead, use this direction and question, “Point to where it hurts the most. Where does your pain go from there?”
Severity
Remember, pain is subjective and relative to each patient you treat. Have an open mind for any response from 0 to 10.
During the course of treatment and transport (for EMTs and paramedics), healthcare providers will ask the patient to re-rate their pain in response to interventions, like pain medication, splinting and the tincture of time. For patient’s with severe, acute pain, ask the patient to rate their pain every five to 10 minutes. For patient’s with less acute or mild pain, you might initially ask for a pain rating every 10 to 15 minutes, but gradually lengthen the interval to every 30-60 minutes. The frequency often depends on the patient’s injury or illness, the available interventions and the duration of care.
Time
Time is a reference to when the pain started or how long ago it started. Ask the patient, “What time did your pain start?” or “How long have you had this pain?”
What comes after OPQRST?
Use the OPQRST acronym wisely to get plentiful and useful clues about your patient’s pain complaint. Then, use the tools, training and protocols available to you to manage the patient’s pain. As the patient’s pain subsides or their mental status improves, consider re-asking the OPQRST questions to better understand the patient’s pain complaint.
This is also an opportune time to investigate for associated signs and pertinent negatives.
This article, originally published March 19, 2009, has been updated with a video and additional resources.
