The Fifth Vital Sign—What Does It Mean?

Abstract

Acute pain is reported as a presenting symptom in over 80% of physician visits. Chronic pain affects an estimated 76.2 million Americans--more than diabetes, heart disease, and cancer combined. It has been estimated to be undertreated in up to 80% of patients in some settings. Pain costs the American public more than $100 billion each year in health care, compensation, and litigation. That's why pain was officially declared "The Fifth Vital Sign." Henceforth the evaluation of pain became a requirement of proper patient care as important and basic as the assessment and management of temperature, blood pressure, respiratory rate, and heart rate. The numeric pain scale certainly has a place in care and in pain management; however, it is important to assess the patient's communication and self-management style and to recognize that patients, like pain, are on a continuum with varied styles of communication and adaptation. It is easy to get lost in the process, even when the process is initiated with the best of intentions. In the quest for individualized medicine, it might be best to keep pain assessment in the individualization arena.

The Numeric Scoring of Pain: This Practice Rates a Zero Out of Ten

“…Social psychology dictates that it is far easier to simply fix the number than it is to take the time to document why the value is misleading, or why therapy is undesirable. As observed by Walid et al, 14 the act of pain scoring "may unintentionally deteriorate into a bureaucratic checklist item supplanting, rather than enhancing, communication." Instead of pain management…”

Providers' Perspectives on Challenges to Contraceptive Counseling in Primary Care Settings

“…As found with pain screening, however, mandatory screening will not ensure that providers respond appropriately to women's need for information, especially if providers lack confidence about their contraceptive knowledge. 38 This study was motivated by our interest in identifying system-based strategies to improve contraceptive counseling within our health system. Although no single intervention is likely to address all barriers to contraceptive counseling in primary care, EMR systems have been proposed as an important systems-based tool for identifying patients in need of contraceptive counseling.…”

Opioid-induced constipation: advances and clinical guidance

“…Pain as the fifth vital sign and the imperative to manage pain Due to the increase in opioid analgesic use for chronic pain, the Joint Commission on Accreditation of Healthcare Organizations (a notfor-profit organization, whose mission is to continuously improve healthcare for the public in the United States) and the Veterans Health Administration introduced the concept of pain as the fifth vital sign in order to draw attention to the need to provide adequate pain relief to patients [Walid et al 2008]. The World Health Organization (WHO) recommended the use of opioids for the management of moderate to severe chronic cancer pain; this strategy has been adopted for patients with chronic noncancer pain in recent years ].…”