Pain Assessment Mnemonics & History

A patient says "it hurts" — but that's not an assessment. The structured history you collect in the next 60 seconds determines whether the right intervention happens or the wrong one does.

Pain assessment mnemonics give you a systematic framework to collect a complete subjective pain history every time. PQRSTU is the gold standard: Provokes/Palliates (what makes it worse or better?), Quality (sharp, dull, burning, aching?), Region/Radiation (where exactly, and does it travel?), Severity (rated on a scale), Timing (onset, duration, constant vs. intermittent), and Understanding/impact on function (how does it affect daily life?). OLDCARTS is the alternative: Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity. Both accomplish the same goal — ensuring you don't skip a dimension. The mnemonic is not the assessment; it's the checklist that prevents you from jumping to severity alone. Quality descriptors are clinically meaningful: "sharp and stabbing" suggests somatic or acute injury; "burning or shooting" suggests neuropathic origin; "deep, aching, poorly localized" suggests visceral pain. These descriptors guide the provider toward the right workup. Document using the patient's own words in quotes. Always reassess after intervention using the same parameters — comparing post-intervention quality and severity to baseline is how you evaluate effectiveness.

Key Distinctions

Don't confuse a pain rating scale (the 0–10 tool) with a pain assessment mnemonic (the full history framework) — severity is one letter in PQRSTU, not the whole assessment. Students often document only location and severity, missing quality and timing, which are the dimensions that differentiate pain types. OLDCARTS and PQRSTU are interchangeable frameworks, not competing standards — know either one thoroughly.

Clinical Pearl

Severity is one slice of the pie, not the whole pie. If your pain documentation is just a number, you haven't assessed — you've only scored.