OPQRST

The “Q” in OPQRST refers to the quality of pain. Some descriptors to describe the quality of the pain include sharp, dull, crushing, burning, and tearing. The pain pattern, such as intermittent, constant, or throbbing, is also important.   

Pain can be divided into nociceptive and neuropathic pain based on the quality of the pain. Nociceptive pain is caused by the activation of sensory nerve fibers called nociceptors, which are found throughout the body, including the skin, muscles, joints, and internal organs. This type of pain generally responds well to analgesic medications like acetaminophen or NSAIDs, like ibuprofen. On the other hand, neuropathic pain is a type of chronic pain caused by damage or dysfunction of the nervous system. Neuropathic pain can lead to various unpleasant sensations, including a burning or tingling sensation; a sharp, electric-like pain; or allodynia, which is described as pain that arises in response to non-painful stimuli, like light pressure or temperature changes. Neuropathic pain requires different pain management strategies than nociceptive pain, which often includes antidepressants like amitriptyline and duloxetine; and neuromodulators, such as pregabalin or gabapentin.  

The “S” in OPQRST refers to the severity of pain. Pain intensity can be assessed through different pain rating scales. One of the most commonly used is the visual analog scale (VAS), where the individual sets the level of pain on a 10 centimeter line that goes from 0 (no pain) to 10 (worst imaginable pain).  

The Wong-Baker FACES pain scale is a tool used for children to help them communicate their pain without words. It consists of six faces with facial expressions that represent different levels of pain so that children can choose the one that best represents what they are experiencing.  

Finally, there is the PAINAD scale, which focuses on assessing objective items to determine the level of pain in people with dementia. These items include breathing, vocalizations (e.g., moaning, groaning, calling out), facial expressions, body language, and consolability.  

The “T” in OPQRST refers to time. Based on its duration, pain can be divided into acute, subacute, or chronic pain. Acute pain is of short duration (usually less than 1 month), it typically arises suddenly and generally resolves when the body heals itself. It often serves as a warning signal, alerting the individual and prompting them to take action to protect themselves (i.e., pulling the fingers away from a hot pan). Subacute pain is acute pain that does not resolve within a month but persists less than 3 months.  

Chronic pain, on the other hand, is often more gradual in onset and typically lasts longer than 3 to 6 months. It can occur as a result of a previous injury or be a symptom of underlying medical conditions, like osteoarthritis, fibromyalgia, endometriosis, or irritable bowel syndrome, to name a few.