SOCRATES is a structured framework used by many healthcare professionals to assess pain.
However, it’s also used in general medical history-taking for patients.
Aside from trying to search for the cause of pain, the process also helps a doctor come up with the proper treatment for the patients.
In this article, we’ll explain what exactly SOCRATES means.
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What Does SOCRATES Stand for in Assessing Pain?
Pain is actually a complicated symptom that can be connected to other signs of a more severe diagnosis. Because of that, asking SOCRATES questions is good practice.
It’s simple enough that even those who don’t have medical skills can ask these questions in a first aid setting to test for preliminary problems.
Below is what each letter of SOCRATES stands for, together with example questions that a patient can be asked:
S-ite
You should, of course, ask, “Where is the pain?“
But since something like “back pain” is still too broad, you should also ask, “Can you point to where exactly the pain is?“
The more specific, the better. They can even answer whether it’s the muscle, skin, or nerves that are bothering them.
That can be especially helpful in pinpointing problems like osteoarthritis that target specific body systems.
If the patient is having a hard time pinpointing EXACTLY where it hurts, have them point to the maximal site of the pain — which is the place that hurts the most.
O-nset
Here, you should establish how and when the pain started.
The main question to ask here is, “When did you start feeling pain?“
Other things to ask are:
- Did the pain start suddenly or gradually?
- What were you doing when you started feeling the pain?
- How long have you been feeling the pain?
If the patient is experiencing intermittent pain, find out when they FIRST felt the pain.
C-haracter
Ask more specific questions about the pain. Have them describe what the pain is like — such as if it’s only an ache or something more serious like burning, stabbing, or crushing.
Also, establish if it’s constant or if it comes and goes, and how often it happens.
R-adiation
This refers to whether the pain moves to other parts of the body.
When you ask, “Does the pain radiate?” you can follow it up with “How often does it happen?“
You can also ask if they’ve noticed when the radiation happens or what they’re doing when it happens.
It might also be helpful to search for where the pain radiates and if it’s the same place every time.
A-ssociated Symptoms
Aside from the pain, ask, “Are you experiencing other symptoms that might be connected to the pain?“
Have the patient mention everything they think is associated with the pain.
If the patient is having a hard time with this, you can help prompt them.
For instance, if they’re experiencing pain in their stomach area, you can ask if they notice blood in their stool. If so, you can narrow down that they have digestive system problems like ulcers and IBD.
Or, if they’ve been dealing with a sore throat for some time, ask if they’re also coughing up some blood. If that’s the case, you might need to give them medicine for possible problems like tuberculosis.
T-ime Course
Find out the pain history — which is if the pain has changed over time.
Ask, “Ever since you started experiencing the pain, has it gotten better, worse, or is it the same?“
You can also ask, “Does the pain follow a pattern?“
E-xacerbating/Relieving Factors
Clarify what makes the pain worse or better.
Ask if they have pain management strategies that can be part of the alleviating factors for the pain.
This would also be a good time to ask, “If you don’t do anything, will you still experience pain?“
That can help distinguish whether the pain the patient is feeling is incident pain or not.
S-everity
Here, you’ll ask how bad the pain is.
Simply ask, “On a scale of one to ten, with ten being the highest, how bad is the pain?“
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Are There Alternatives to SOCRATES for Pain History Taking?
SOCRATES is just one example of how clinicians, regardless of skills, can undergo pain history taking.
Below are alternatives:
- OLDCARTS – Onset, Location/Radiation, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity
- SCHOLAR – Symptoms, Characteristics, History, Onset, Location, Aggravating factors, Remitting factors
- COLDER AS – Characteristics, Onset, Location, Duration, Exacerbation, Remitting factors, Associated symptoms, Severity
- CLEARAST – Characteristics, Location, Exacerbation, Alleviation, Radiation, Associated symptoms, Severity, Time course
- LIQOR AAA – Location, Intensity, Quality, Radiation, Alleviating and Aggravating factors, Associated signs
- [O]PQRST – [Onset], Provocation or Palliation, Quality, Region, Severity, Time
- Stanford Five – This is a medical pain management assessment that can present pain from the patient’s perspective. The five components are:
- Cause – What the patient believes to be the cause of the problem.
- Meaning – This involves the psychological aspect of the problem since it involves what they believe the pain to mean — including any beliefs or superstitions that can lead to the supposed diagnosis.
- Impact – How the pain affects their quality of life.
- Goals – What they expect from further medical treatments.
- Treatment – What they believe needs to be done to resolve the diagnosis.
Can You Use SOCRATES For Non-Pain History?
Yes, you can. SOCRATES is traditionally intended for patients who are presenting complaints of pain. But it can also be used as an initial test to question patients about their history of symptoms.
Below are a few examples you can ask someone who’s NOT experiencing chronic pain:
- Where are you feeling your symptoms?
- When did you start feeling sick?
- Can you describe what you’re feeling more?
- Have you noticed other symptoms that can be related to what you’re feeling?
- Is there a particular time of day that you feel sick? Or is it constant all throughout?
- How do you manage your symptoms? What makes them better/worse?
- How are your symptoms affecting your daily activities?
You can make your questions more specific to what the patient is feeling so you can more easily search for and solve the problem.
For instance, for shortness of breath, you can ask questions like:
- When did you start feeling shortness of breath?
- How is it affecting your daily activities?
- How far are you able to walk before you start feeling breathless?
It’s important to remember that SOCRATES is more of a guide than a rigid framework.
That’s because not every letter in the mnemonic is applicable to all symptoms.
If the problem is shortness of breath, for example, asking, “Does the symptom spread?” doesn’t work.
Example of Using SOCRATES for Chest Pain
We’ll use chest pain to show you how the example questions can be used by a doctor:
- Site – Can you point to where exactly the pain is?
- Onset – Since when have you started feeling the pain? Was it sudden or gradual?
- Character – Can you describe your pain? Does it feel like burning or stabbing?
- Radiation – Does the pain move to other parts of your body?
- Associated symptoms – Have you noticed other symptoms that you can associate with the pain?
- Time course – What’s the history of the pain? Is it better or worse than when it started?
- Exacerbating and relieving factors – What are examples of tasks that can make the pain better or worse?
- Severity – On a scale of one to ten, how would you assess your pain?
Final Words
SOCRATES is an assessment used to learn a patient’s medical history. It’s a useful way to search for the cause of pain and other symptoms.
It’s also simple enough for children to answer.
It’s also especially helpful in first aid scenarios where people without medical skills can check the person in need.
However, it should be used only as a preliminary test to help narrow down what problem a patient might have. After questioning them, they should undergo more tests to pinpoint what exactly their diagnosis is.
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