For patients with abdominal pain, causes range from benign to life threatening, so take the time to conduct a careful history.

■ First determine the timing of the pain. Is it acute or chronic? Acute abdominal pain has many patterns. Did the pain start suddenly or gradually? When did it begin? How long does it last? What is its pattern over a 24-hour period?  Over weeks or months? Is the illness acute, or chronic and recurring?

■ Ask patients to describe the pain in their own words. Pursue important details: "Where does the pain start?" "Does it radiate or travel anywhere?" "What is the pain like?" If the patient has trouble describing the pain, try offering several choices: "Is it aching, burning, gnawing . . . ?"

■ Then ask the patient to point to the pain. Patients cannot always clearly describe the location of pain in words. The quadrant where the pain is located helps identify the underlying organs that may be involved. If clothes interfere, repeat the question during the physical examination.

■ Ask the patient to rank the severity of the pain on a scale of 1 to 10. Note that severity does not always help identify the cause. Sensitivity to abdominal pain varies widely and tends to diminish in older adults, masking acute abdominal conditions. Individual differences in pain thresholds and accommodation to pain during daily activities also affect ratings of severity.

■ As you explore factors that aggravate or relieve the pain, pay special attention to body position, association with meals, alcohol, medications (including aspirin and aspirin-like drugs and any over-the-counter medications), stress, and use of antacids. Ask if indigestion or discomfort is related to exertion and relieved by rest.

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