By Dr. Anthony Policastro

Last week I wrote about a mnemonic that I created for diagnosing migraine headaches. I want to share another mnemonic that I created to address pain. There are many questions that can be asked about pain. However, if the questions are focused, they can help point to the diagnosis.

I had to take Latin in school. So I used a Latin name Quintus Quintus Scala to ask pain questions. I called it QQSCALA.

The first question was related to the Quality of the pain. I would ask the patient in their own words what the pain felt like. It might be heavy like a weight. It might be pinching in nature. It might feel like pins and needles. It might feel like getting hit with a hammer.

The second question was related to the Quantity of the pain. This was usually asked in terms of how much pain there was on a scale of 1 to 10 with 10 being the worst. This question is commonly asked at most medical offices when someone presents with pain. It is something that most patients are familiar with.

The third question was related to Setting. When does the pain seem to occur? It might hurt only with movement. It might hurt in relation to mealtime. It might hurt with pressing on an area. There are many opportunities to narrow the source of pain down with these kinds of questions.

The fourth question is Chronology. This is related to the timing of the pain. It might be something that is there all the time. It might be something that comes and goes. It might be something that is related to a certain time of day.

The fifth question is Asking about Associated symptoms. This refers to things that might happen in addition to the pain. It might refer to something like nausea. It might refer to something like dizziness. These other symptoms sometimes help narrow down the potential causes of the pain.

The sixth question refers to Location. Sometimes the pain is in a certain location. Sometimes it moves around. Sometimes it is in more than one location.

The last question is what are called Alleviating (things that make the pain better) and Aggravating (things that make the pain worse) circumstances. For example some abdominal pain gets better with meals. Other abdominal pain gets worse with meals.

If someone is going to see their physician about pain, they can expect to be asked these kinds of questions. Going in prepared to answer them will allow the physician to more quickly decide on what might be causing the pain. This will help with both diagnostic and treatment options.

We learned some mnemonics in medical school to help us remember things like parts of the human body. However, there are more uses than that for these kinds of things.