Patient: January March May July August October December Year: 200

Pelvic Pain Record

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
# of Pains

Type or Quality
of pain? What
does it feel like?

Region and
Radiation. Location
of pain, and where it
radiates?

Severity (1-10)

O – Onset.
When and how
did it start?
Timing. Is
there a time
pattern?
When, how
long, constant,
intermittent?
Severity (1-10) - 1-3 - well tolerated, mild pain at rest or w/ movement 4-6 - moderate pain at rest, significant pain w/ movement, not an emergency: 7-8 - serious problem & very distressing,
frequent pain at rest & severe pain w/ movement: 9-10 - perceived emergency to patient, pain is overwhelming and is continuously severe at rest & excrutiating w/ movement.

The OPQRST Mnemonic: O – Onset. When and how did it start? P – Provocative and Palliative. What aggravates it? What relieves it? Q – Quality. Is it sharp, dull, throbbing, burning, crushing,
etc.? R – Region and Radiation. Location of pain, and where it radiates? Be as specific as you can. S – Severity. Is it incapacitating or is it mild? Does it affect ability to work or play? T – Timing. Is
there a time pattern? When, how long, constant, intermittent?

Quality Types: Aching, Burning, Crushing, Crampy, Deep, Dull, Electric, Gnawing, Knot-like, On the surface, Pinching, Pins & needles, Pounding, Pressing, Prickling, Pulsing, Sharp,
Shooting, Sore, Stabbing, Stretching, Tender, Throbbing, Tight
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
# of Pains

Type or Quality
of pain? What
does it feel like?

Region and
Radiation. Location
of pain, and where it
radiates?

Severity (1-10)
 O – Onset.
When and how
did it start?
Timing. Is
there a time
pattern?
When, how
long, constant,
intermittent?
Patient: February April June September November Year: 200
Pelvic Pain Record
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
# of Pains

Type or Quality
of pain? What
does it feel like?

Region and
Radiation. Location
of pain, and where it
radiates?

Severity (1-10)

O – Onset.
When and how
did it start?
Timing. Is
there a time
pattern?
When, how
long, constant,
intermittent?
Severity (1-10) - 1-3 - well tolerated, mild pain at rest or w/ movement 4-6 - moderate pain at rest, significant pain w/ movement, not an emergency: 7-8 - serious problem & very distressing,
frequent pain at rest & severe pain w/ movement: 9-10 - perceived emergency to patient, pain is overwhelming and is continuously severe at rest & excrutiating w/ movement.

The OPQRST Mnemonic: O – Onset. When and how did it start? P – Provocative and Palliative. What aggravates it? What relieves it? Q – Quality. Is it sharp, dull, throbbing, burning, crushing,
etc.? R – Region and Radiation. Location of pain, and where it radiates? Be as specific as you can. S – Severity. Is it incapacitating or is it mild? Does it affect ability to work or play? T – Timing. Is
there a time pattern? When, how long, constant, intermittent?

Quality Types: Aching, Burning, Crushing, Crampy, Deep, Dull, Electric, Gnawing, Knot-like, On the surface, Pinching, Pins & needles, Pounding, Pressing, Prickling, Pulsing, Sharp,
Shooting, Sore, Stabbing, Stretching, Tender, Throbbing, Tight
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

# of Pains

Type or Quality
of pain? What
does it feel like?

Region and
Radiation. Location
of pain, and where it
radiates?

Severity (1-10)
 O – Onset.
When and how
did it start?
Timing. Is
there a time
pattern?
When, how
long, constant,
intermittent?