Pain Assessment Framework: OPQRST

Universal structured method for taking a comprehensive history of presenting pain in clinical practice.

Used worldwide across internal medicine, emergency departments, and cardiology to characterize symptoms and build targeted differential diagnoses.

Systematic Breakdown

Was the onset sudden (e.g. aortic dissection, ruptured aneurysm) or gradual/insidious (e.g. appendicitis, peptic ulcer)?

What makes the pain worse or better? (e.g. relief with sitting forward in pericarditis, worse with food in gastric ulcer).

Describe the pain: sharp, dull, burning, crushing, tearing, colicky, or throbbing.

Where is it located, and where does it radiate? (e.g. left arm/jaw in MI, back in pancreatitis or aortic dissection).

Pain scale rating from 0 to 10; comparison to previous pain episodes.

Duration, constant vs intermittent, frequency, and changes over time.

High-Yield Clinical Pearls & Exam Tips

Tearing pain radiating to the back is classic for acute aortic dissection until proven otherwise.
Crushing substernal pressure with radiation to jaw or left arm is classic for ischemic myocardial injury.

Related Pharmaceuticals

Morphine Fentanyl Acetaminophen Ketorolac

Related Clinical Conditions

Myocardial Infarction Aortic Dissection Acute Appendicitis

Authoritative Sources: Bates' Guide to Physical Examination and History Taking 13e · MacLeod's Clinical Examination 14e