OPQRST

OPQRST is a mnemonic used in medical history-taking to characterize a patient's pain or symptoms. It provides a structured framework for gathering essential information, particularly when evaluating chest pain or other acute presentations. The letters stand for onset, provocation/palliation, quality, region/radiation, severity, and timing.

Onset refers to when the symptom began and under what circumstances. Provocation or palliation asks what factors worsen or relieve it. Quality describes the character of the pain or sensation (for example, sharp, dull, burning). Region and radiation identify the location and whether the pain spreads to other areas. Severity is typically assessed on a scale (for example, 0 to 10). Timing covers the duration, pattern, and progression of the symptom.

Application: Clinicians use OPQRST in emergency departments, clinics, and prehospital care to rapidly gather critical details that inform differential diagnosis and triage. For example, in chest pain, onset during exertion, provocation by activity, a pressure-like quality, retrosternal region with left arm radiation, severity 7 out of 10, and persistent timing after initial onset would raise concern for possible cardiac ischemia. It is a guide, not a diagnosis.

Variants: Some versions add an extra letter, such as U, to denote associated symptoms or to capture the patient’s understanding of their condition. Practices vary, and OPQRST is most effective when used alongside other history questions, physical examination, and diagnostic testing.

History and scope: OPQRST has long been taught in medical education and emergency medicine as a standard approach to pain assessment, valued for its simplicity and comprehensive coverage of pain characteristics.