SOCRATES pain assessment

This is a useful mnemonic to systematically explore each aspect of the pain a patient is experiencing. This allows the pain to act as a useful source of information in diagnosis.

This can be demonstrated with the example of a headache presentation:

• Site: 
• Headache location (e.g. hemi-cranial).
• Onset
• Sudden onset in less than 1 minute (beware subarachnoid haemorrhage). 
• Age at onset and headache frequency.
• Character
• E.g. throbbing versus non-throbbing
• Radiation
• Associated symptoms
• E.g. nausea, photophonia, phonophobia and motion sensitivity. 
• Fever (meningitis, sinusitis). 
• Features of raised intracranial pressure. 
• Presence of autonomic symptoms, e.g. tearing or ptosis. 
• Jaw claudication (giant cell arteritis).
• Time course
• Duration of headache episodes (helpful in distinguishing between different primary headache types). 
• Headache pattern. 
• Is headache episodic and part of a pattern of previous similar headaches?
• Exacerbating/Relieving features
• E.g. effect of posture.
• Severity
• Worst pain of their life (beware subarachnoid haemorrhage).