Moving Beyond Pain as the Fifth Vital Sign and Patient Satisfaction Scores to Improve Pain Care in the 21st Century

Abstract

In an attempt to address the issue of undertreated pain, the Pain as the Fifth Vital Sign (P5VS) Initiative was established to improve the quality of pain care across clinical settings. This initiative included policy efforts such as mandatory pain screening and the implementation of pain-related questions on patient satisfaction surveys. These policies have failed to enhance the treatment of pain and may have unintentionally contributed, in part, to the opioid epidemic. To assess pain more effectively, an inter-professional team approach using multi-dimensional pain assessment tools is needed. The inter-professional team can use these multi-dimensional tools to conduct comprehensive assessments to measure aspects of the pain experience (e.g., psychological, spiritual and socio-emotional pain; impact on daily functioning) beyond its sensory component and establish realistic goals that align with patients' needs. To implement multi-dimensional pain assessments in busy clinical practices, nurses will need to play a central role. Nurses can work to ensure that patients complete the questionnaires prior to the visit. Nurses can also take the lead in the use of new technologies in the form of tablets, smart phones, and mobile apps to facilitate collecting patient-level data in the home or in a waiting room before their visits.

Dynamics on the field: A focused ethnographic study of pediatric pain management at four Ghanaian hospitals

“…Although pain is regarded as of high symbolic capital and considered as the fifth vital sign by international bodies [48,49] , we found that pain did not receive the same level of attention for assessment as the traditional four vital signs (temperature, respiration, pulse and blood pressure) in these Ghanaian hospitals. Healthcare providers admitted to not being able to assess pain in nonverbal children due to their lack of cultural capital in this regard and heavily relied on the social capital provided by family caregivers who were sometimes clueless about how to assess pain in their children.…”

Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional Self-Report Methods Can Offer

“…Routine acute pain assessment often does not extend beyond quantifying pain intensity, and a purely perceptual model of pain is at best incomplete. What began as an innovative initiative to measure acute pain now leaves many clinicians often failing to fully appreciate the biopsychosocial complexity of the acute pain experience, sometimes devising entire pain management plans based on a mere numerical value for pain intensity [110], consequently resulting in limited improvements in patient outcomes [9,111]. The focus now needs to be on a conceptual and cultural shift from unidimensional assessment of acute pain to a more comprehensive, multidimensional assessment of acute pain.…”

Predictive Risk Factors Associated With Increased Opioid Use Among Patients Undergoing Elective Spine Surgery

“…The use of opioid analgesia has increased following the introduction of the Pain as the Fifth Vital Sign campaign of the mid-1990s. 1,2 Concurrently, international collaborations such as those published in the Lancet as part of the 2013 Global Burden of Disease Study have identified chronic back and neck pain as a leading cause of disabilityadjusted life-years lost worldwide. 3 Patients suffering from such complex pain syndromes often experience impairment in function and quality of life, usually requiring multimodal treatment options which may include opioid medication management.…”