Pain is treated as the “fifth vital sign” and is a subjective assessment detail that offers additional insight into the patient’s comfort and health status. Nurses often ask patients to rate their pain using a numerical scale to gauge the severity, but inquiring further into the patient’s pain can guide appropriate interventions or alert the nurse to developing complications.
In this article:
- The PQRST Framework
- Completing the Clinical Picture
- Nursing Pearl: Pain is What the Patient Says it is
- Documentation and Reassessment
- Mastering Comprehensive Pain Assessments
- References
The PQRST Framework
The PQRST mnemonic is used to assess multiple characteristics of the patient’s pain. A comprehensive pain assessment is crucial for understanding the underlying cause and planning the most effective interventions, thereby improving patient outcomes.
PQRST stands for:
- Provoking & Palliating
- Quality
- Region & Radiation
- Severity
- Timing
Provoking and Palliating Factors
Ask the patient what provokes (triggers) their pain. This can include things like poor sleep, changes in the weather, movement, deep breathing, and more. It’s also important to inquire if there is anything that palliates, or makes the pain better, such as rest, heat, or medication.
Quality
The quality of the patient’s pain refers to describing how it feels. Encourage the patient to use descriptive language like “throbbing,” “aching,” or “burning,” as this provides crucial insight into types of pain and underlying causes. For example, burning or tingling pain often signals neuropathic pain or nerve damage. If the patient describes their chest pain as a “squeezing” pressure, this is a very concerning clue to the possibility of cardiac ischemia requiring immediate evaluation.
Region and Radiation
Identifying the exact location of the pain is paramount. A patient reporting abdominal pain is very vague, as each quadrant of the abdomen is associated with different potential causes. Have the patient use one finger to point to the exact location of their pain. Next, ask the patient if the pain radiates or spreads to other areas. Chest pain that radiates to the arm or jaw is another concerning sign of possible myocardial infarction.
Severity
This is where the nurse can ask the patient to rate their pain on a scale of 0-10, with 0 describing no pain and 10 indicating the worst pain imaginable. The Wong Baker FACES scale can be implemented for children or patients with language or cognitive barriers.
A Note About Chronic Pain
A numerical rating of “0” or a goal of “no pain” may not be realistic for a patient with chronic pain. In this instance, include a goal in the plan of care that is reasonable for the patient and their health. This may look like being able to perform a certain activity, participate in ADLs, or ambulate down the hallway.
Timing
Lastly, the nurse should determine several clues related to the timing of the patient’s pain, which include the following questions:
- Onset: Is the pain sudden, occurring in the past few hours or days (acute) or ongoing for several months (chronic)?
- Frequency: Is the pain continuous or intermittent?
- Duration: If the pain is intermittent, how long do pain episodes last?
- Trends: Is the pain stable, worsening, or improving? Does the pain occur at a specific time of day?
Completing the Clinical Picture
Along with these subjective reports, the nurse should also assess for objective findings of pain.
Non-verbal cues like facial grimacing, crying, or guarding the painful area are outward signs of pain. Note that just because the patient may not display signs of pain does not mean their pain is not real.
Alterations in vital signs frequently correlate with pain. An increase in blood pressure, heart rate, and respiratory rate occurs with severe acute pain.
Nursing Pearl: Pain is What the Patient Says it is
Remember that pain is a subjective finding. This means it is whatever the patient says it is. Everyone experiences pain differently and has varying pain tolerances, which is another reason why using the PQRST tool and diving deeper into the patient’s pain matters. It is your duty as a nurse to take the patient’s pain seriously and to provide optimal, safe pain management.
Documentation and Reassessment
The following is an example clinical note related to pain, implementing the PQRST tool:
- P: The pain started suddenly after lifting a box this morning.
- Q: Patient describes the pain as dull and aching.
- R: Patient points to the right side of the lower back.
- S: Patient rates the pain 7/10.
- T: The pain began 4 hours ago and has not improved.
After further evaluation (if necessary), the nurse will implement the provider’s orders, which may include medication, heat, ice, compression, etc. Regardless of the actions provided, the nurse should reassess the patient’s pain within 30-60 minutes to evaluate effectiveness.
Mastering Comprehensive Pain Assessments
Pain is a debilitating symptom of many medical conditions, yet it is often difficult to manage appropriately. By applying the PQRST framework, you move beyond merely treating a number to understanding your patient’s pain and providing individualized, compassionate, and successful pain management.
References
- Debra R. Gordon; Susan M. Rees; Maureen P. McCausland. Improving Reassessment and Documentation of Pain Management. Accessed November 2025. https://heilbrunnfamily.rucares.org/assets/file/pain%20management.pdf
- Donna L. Wong; Connie M. Baker. Wong-Baker FACES History. Accessed November 2025. https://wongbakerfaces.org/us/wong-baker-faces-history/
- Meredith Barad; Anuj Aggarwal. Evaluation of Pain. Accessed November 2025. https://www.merckmanuals.com/professional/neurologic-disorders/pain/evaluation-of-pain
- Michael F. Stretanski; Samuel Stinocher; Sundeep Grandhe. Pain Assessment. Accessed November 2025. https://www.ncbi.nlm.nih.gov/books/NBK556098/
- Tammy J. Toney-Butler; Wendy J. Unison-Pace. Nursing Admission Assessment and Examination. Accessed November 2025. https://www.ncbi.nlm.nih.gov/books/NBK493211/
