Pain assessment · Updated October 2026
SOCRATES pain assessment tool
Work through the eight steps of the SOCRATES pain assessment: Site, Onset, Character, Radiation, Associated symptoms, Time course, Exacerbating and relieving factors, and Severity. The summary builds as you go, flags warning signs, and can be copied into care notes.
For guidance only. This tool does not diagnose the cause of pain or replace advice from a doctor, nurse or pharmacist. Nothing you enter is saved or sent anywhere.
What is the SOCRATES pain assessment?
SOCRATES is a mnemonic used across the NHS and social care to take a structured pain history. Each letter prompts a question, so nothing important is missed. It is especially useful for new, changing or unexplained pain, and works alongside a pain scale for measuring severity, such as our Numeric Rating Scale (NRS) pain assessment tool.
Free download
SOCRATES pain assessment tool (PDF)
A printable SOCRATES form to complete on paper and keep in the person’s care records.
How to use the SOCRATES pain assessment tool
- 1Ask open questionsLet the person describe the pain in their own words before using the prompts.
- 2Work through each letterTap a letter at the top to jump to that step. Letters turn dark when complete.
- 3Check warning signsThe tool flags combinations that need urgent help, such as chest pain with breathlessness.
- 4Record and actCopy the summary into care notes, follow the care plan, and reassess after pain relief.
SOCRATES explained: what each letter means
| Letter | Stands for | Questions to ask | Why it matters |
|---|---|---|---|
| S | Site | Where is the pain? Can you point to it? | Helps narrow down the cause and shows if pain is in more than one place. |
| O | Onset | When did it start? Was it sudden or gradual? What were you doing? | Sudden pain can signal an emergency. Gradual pain may suggest a long-term problem. |
| C | Character | What does it feel like: aching, sharp, burning, throbbing? | Different types of pain point to different causes, such as nerve, muscle or organ pain. |
| R | Radiation | Does the pain spread or move anywhere else? | Spreading pain, such as chest pain moving to the arm or jaw, can be a warning sign. |
| A | Associated symptoms | Do you have anything else, such as sickness, fever or breathlessness? | Other symptoms help build the full picture and spot serious problems. |
| T | Time course | Is it constant or does it come and go? Is it getting worse? | Shows patterns, such as pain at night, and whether it is improving. |
| E | Exacerbating and relieving factors | What makes it worse? What helps? | Guides care, positioning and pain relief, and shows what has already been tried. |
| S | Severity | On a scale of 0 to 10, how bad is it? | Gives a score to compare over time and after pain relief. |
SOCRATES pain assessment example
Joan, 81, lives in a care home and tells her carer her back is hurting. Her carer uses SOCRATES:
- SLower back, right side
- OStarted yesterday, gradually, after helping her into the bath
- CAching, sometimes sharp
- RSpreads down the back of her right leg
- ANo fever, no numbness, eating normally
- TConstant, worse in the morning
- EWorse when moving and standing; better with rest, heat and her prescribed paracetamol
- S5 out of 10 now, 7 out of 10 at worst
There are no warning signs, so the carer records the assessment, offers heat and rest, follows Joan’s care plan for pain relief, and tells the nurse in charge. Because the pain spreads down her leg and started after a transfer, the nurse asks the GP to review her.
Red flags: when pain needs urgent help
Call 999 for
- Chest pain, especially if it feels crushing or tight, spreads to the arm, jaw or back, or comes with breathlessness or sweating.
- A sudden, severe headache, often described as the worst ever.
- Sudden numbness, weakness or drooping on one side of the face or body.
- Pain with fever and new confusion, which could be sepsis.
- Severe pain after a fall, or being unable to bear weight.
For other new, severe or worsening pain, call NHS 111 or the GP the same day.
SOCRATES and other pain assessment mnemonics
SOCRATES
Site, Onset, Character, Radiation, Associated symptoms, Time course, Exacerbating and relieving factors, Severity. Widely used in UK health and care.
OPQRST
Onset, Provocation or palliation, Quality, Region and radiation, Severity, Time. Common in emergency and pre-hospital care.
PQRST
A shorter version: Provocation, Quality, Region, Severity, Time. Quick to use at the bedside.
Using SOCRATES with people who can’t describe their pain
People living with dementia, learning disabilities or communication difficulties may not be able to answer every question. Use what you can observe, ask family and staff who know the person well, and add an observational pain scale such as the Abbey Pain Scale or PAINAD for severity.
- Site: watch for guarding, rubbing or not wanting a body part touched.
- Onset and time: check notes for when behaviour changed, and whether it follows a pattern.
- Exacerbating factors: notice if distress increases with moving, eating or personal care.
Recording a SOCRATES pain assessment
- Use the person’s own words where you can, especially for character.
- Record the date, time and who carried out the assessment.
- Note any pain relief given and reassess 30 to 60 minutes later.
- Share new or worsening pain with the nurse in charge or GP, and update the care plan.
About this SOCRATES tool
- Severity uses the 0 to 10 Numeric Rating Scale: 0 none, 1–3 mild, 4–6 moderate, 7–10 severe.
- Warning signs are flagged from common combinations only. Always use your own judgement and escalate if you are worried.
- Avoid entering names or other personal details. Nothing is saved, and the summary is cleared when you leave the page.
Frequently asked questions about SOCRATES pain assessment
What is SOCRATES in pain assessment?
SOCRATES is a mnemonic for a structured pain assessment. It stands for Site, Onset, Character, Radiation, Associated symptoms, Time course, Exacerbating and relieving factors, and Severity.
Who uses the SOCRATES pain assessment tool?
Doctors, nurses, paramedics, nursing associates, care workers and students use SOCRATES to take a pain history, especially for new or changing pain.
Is there a free SOCRATES pain assessment PDF?
Yes. You can download the free SOCRATES pain assessment tool (PDF) to print and use on paper.
What is the difference between SOCRATES and OPQRST?
Both are pain assessment mnemonics. OPQRST stands for Onset, Provocation or palliation, Quality, Region and radiation, Severity, and Time. SOCRATES adds associated symptoms and is common in the UK, while OPQRST is common in emergency care.
How is severity measured in SOCRATES?
Severity is usually measured with the 0 to 10 Numeric Rating Scale, where 0 is no pain and 10 is the worst pain imaginable. For people who cannot use numbers, use a faces or observational pain scale. You can rate and track pain with our free NRS pain assessment tool.
Can SOCRATES be used for people with dementia?
Partly. If the person can’t answer, ask family and staff who know them, observe for signs of pain, and use an observational tool such as the Abbey Pain Scale or PAINAD alongside SOCRATES.
When is pain an emergency?
Call 999 for chest pain with breathlessness or sweating, a sudden severe headache, sudden weakness or numbness, or pain with fever and new confusion. For other worrying pain, call NHS 111 or the GP.
Is my information saved?
No. Everything you enter stays in your browser and is cleared when you leave the page. Avoid entering names or other personal details.