A pain number is not a pain assessment.
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In 30 seconds
- 1The number tracks intensity; PQRST or OLDCARTS describes the experience, context, pattern, and associated cues.
- 2Pick the scale the patient can use: numeric, faces, or behavioral when reliable self-report is not possible.
- 3Use the same appropriate scale before and after an intervention so the change is interpretable.
The number helps track intensity, while PQRST or OLDCARTS describes the experience, context, pattern, and associated cues that determine what the nurse should assess or do next. Use the same appropriate scale before and after an intervention so the change is interpretable.
PQRST and OLDCARTS
- PQRST: provocation/palliation, quality, region/radiation, severity, timing.
- OLDCARTS: onset, location, duration, character, aggravating/alleviating factors, radiation, timing, severity.
Both organize a history. Neither should delay an urgent ABC response when pain arrives with instability, acute neurologic change, or another emergency cue, the same rule that interrupts a head-to-toe assessment.
Three common scale families
Choosing the scale
Pick the scale the patient can actually use
Self-report 0–10
Numeric rating scale
Patient: Can understand and use numbers consistently
Visual self-report
Faces scale
Patient: Can match their experience to the faces and instructions
Observed behaviors
Behavioral scale
Patient: Cannot provide reliable self-report
Scale selection depends on age, cognition, condition, intervention, orders, and organizational policy.
Numeric rating scale: a self-reported 0–10 intensity for a person who can understand and use numbers consistently.
Faces scale: a visual self-report option for patients who can match their experience to the faces and instructions.
Behavioral scale: observable behaviors for patients who cannot provide reliable self-report; behavior supports assessment but does not prove absence of pain.
Then close the loop. Reassess with the same scale after the intervention, so the change is interpretable.
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A client reports new severe abdominal pain. What should the nurse do first?
Which scale is most appropriate for an older adult with advanced dementia who cannot self-report reliably?
Which description most strongly suggests neuropathic pain?
Each question above carries a one-line rationale on every option and a full explanation underneath, the format on every one of the 6,463 NurseSavvy questions. The five pain topics below are learning flows: scale selection and the PQRST history are Recall and Recognize-Cues cards, and the reassessment loop is the Evaluate Outcomes rung, with a missed card back in the same session and again at 4 hours → 1 day → 3 days → 7 days → 21 days → 60 days.
Five connected pain topics
- Pain assessment mnemonics and history
- Pain rating scales
- Types of pain
- WHO pain ladder and multimodal care
- Patient-controlled analgesia
Document the whole loop
Record the patient’s report, selected scale, focused cues, intervention, reassessment time, response, functional change, and any adverse findings. “Pain improved” is weaker than a repeated score plus what the patient can now do. The same assess-act-evaluate structure runs through a nursing care plan, and the other numbers you reassess are in vital signs normal ranges.
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A patient cannot provide reliable self-report. Which scale family fits?
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Clinical-context note: Scale selection, reassessment intervals, medication parameters, and escalation thresholds depend on age, cognition, condition, intervention, orders, and organizational policy.
Common questions
What does PQRST stand for in pain assessment?
Provocation or palliation, quality, region or radiation, severity, and timing.
What does OLDCARTS stand for?
Onset, location, duration, character, aggravating or alleviating factors, radiation, timing, and severity.
What are the main types of pain scales?
Common families include numeric self-report scales, faces self-report scales, and validated behavioral tools for patients who cannot self-report reliably.
What should be documented after a pain intervention?
Document the original assessment and scale, intervention, reassessment time, repeated score, functional response, associated findings, and any adverse effects or escalation.