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SOCRATES - pain checklist

SOCRATES: Site, Onset, Character, Radiation, Associated features, Timing/duration, Exacerbating/Alleviating factors (e.g., response to NSAIDs), Severity 


  • Unilateral, focal, persistent pain is concerning.
  • Referred pain from the hip may present as thigh or knee pain e.g., transient synovitis. 
  • Flitting pain from one joint to another with or without joint swelling can be indicative of acute rheumatic fever. 
  • Persistent night waking with other concerning features (limp, unilateral pain) – think of red-flag conditions. Leg pain at night can also be due to growing pains but caution is needed.
  • Mechanical or inflammatory pain – mechanical (worse with activity, end of the day) or inflammatory pain (associated with stiffness or gelling, worse in morning, may improve with activity).

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