What historical attributes must always be asked about when obtaining the history from a patient with abdominal pain?
The mnemonic PQRST provides a framework that ensures a full exploration of a given patient’s abdominal pain:
- P: Factors that p alliate or p rovoke abdominal pain. For example, pain from pancreatitis is improved with sitting forward. Pain from kidney stones is worsened with movement
- Q: Q ualities of the pain (burning, sharp, crampy, dull)
- R: R adiation of pain. For example, biliary tract pain radiates to the right periscapular region; pancreatic pain radiates to the back; and subdiaphragmatic pain may be referred to the shoulder tips.
- S: S everity of the pain. This is often rated on a scale from 1 to 10.
- T: T emporal events associated with the pain (duration of pain, constant or intermittent, new or chronic)
Another commonly used mnemonic is OLDCARTS. Physicians often prefer this mnemonic as it includes an assessment of the significance of the pain:
- O: O nset of pain
- L: L ocation of pain
- D: D uration of pain
- C: C haracteristics of the pain
- A: A ggravating and alleviating factors
- R: R adiation of the pain
- T: T reatments already tried for the pain
- S: S ignificance of the pain to the patient