Chapter 4 – Pain Assessment
PQRSTU Mnemonic
The PQRSTU mnemonic is a multidimensional pain assessment tool that is commonly used in practice to evaluate several components of pain beyond just intensity (see Table 3). It is used when first assessing a client’s report of pain on initial assessment. It is generally used for adolescents and adults, but you may be able to simplify some of the questions for younger children, possibly age five and up. For example, you might use the word “hurt” or “owwie.”
The order of questions you ask will depend on the client’s responses and also on priority. What do you need to know first? When a client first reports pain, you will usually ask about the region (where it is located) and the intensity. Pay attention to responses that appear not to align. For example, if a client responds to the question about the quantity of pain by saying “the pain isn’t too bad,” but then rates the severity of their pain as being 8/10, you should probe further in a non-confrontational manner. You might say, “I noticed you rated your pain fairly high, at 8/10, but you said it isn’t too bad. Can you tell me more about that?”
The PQRSTU mnemonic is similar to the McCaffrey Initial Pain Assessment Tool, which assesses the various components of pain beyond intensity (e.g., location, quality) as well as how the client expresses their pain and how pain affects them (e.g., sleep, emotions) (McCaffery & Pasero, 1999). Here is a link to the McCaffrey Initial Pain Assessment Tool: https://nida.nih.gov/sites/default/files/McCaffreyInitialPainAssessmentTool.pdf
Table 3: PQRSTU mnemonic (Adapted from https://ecampusontario.pressbooks.pub/healthassessment/)
|
PQRSTU |
Questions Related to Pain |
|
Provocative Palliative |
What makes your pain worse? What makes your pain feel better? |
|
Quality |
What does the pain feel like? Note: If the client struggles to answer this question, you can provide suggestions such as “aching,” “stabbing,” “sharp,” “burning.” |
|
Quantity |
How bad is your pain? Note: for example, the client may say “very bad.” |
|
Region and Radiation |
Where do you feel the pain? Can you point to where you feel the pain? Do you feel the pain elsewhere? Does it radiate anywhere? |
|
Severity (used interchangeably with intensity) |
How would you rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you’ve ever experienced? |
|
Timing |
When did the pain start? Did the pain begin suddenly? What were you doing when the pain started? Where were you when the pain started? Is the pain constant or does it come and go? If the pain is intermittent, when did it last occur? How long does the pain last? Is there a time of day when it is the worst? |
|
Treatment |
Have you taken anything to help relieve the pain? Have you tried any treatments at home for the pain? |
|
Understanding |
What do you think is causing the pain? How has it affected your usual activities or daily life? What concerns do you have about your pain? |
Activity: Check Your Understanding
References
McCaffery, M., & Pasero, C. (1999). Pain: clinical manual (2nd ed). Mosby.
