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An Important View on Pain as a 5th Vital Sign

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Since the first century, “Calor, dolor, rubor and tumor,” i.e., heat, pain, redness and swelling, have been recognized as classical signs of a serious health problem, but there has never been a “litmus test” for measuring the severity of pain itself. In the mid-90s a group of clinicians, policy wonks, and patient advocates developed Pain as the Fifth Vital Sign to increase pain assessment and improve pain care. Since its inception, this strategy has been controversial.
Acceptance of Pain as the 5th Vital Sign by the American Pain Society, the Department of Veterans Affairs, The Joint Commission (TJC) and others resulted in a flurry of optimistic dialogue among advocates for improved pain care. The recent brouhaha about Pain as the 5th Vital Sign presents a negative image of this earlier discourse and stems from efforts by those who believe that it has caused or significantly contributed to the current opioid “epidemic.”
We are pleased to announce the release of An Important View on Pain as a 5th Vital Sign, which is the eighth in a series of briefs profiling policy and educational issues important to improving chronic pain. We wish to thank contributors Jeffrey Fudin, PharmD, DAAPM, FCCP, FASHP, Erica L. Wegrzyn, BS, PharmD, Mena Raouf, PharmD, and Michael Schatman, PhD, and editors Richard Payne, MD, John B. Francis Chair, Center for Practical Bioethics, Bob Twillman, PhD, FAPM, Executive Director, Academy of Integrative Pain Management and James Cleary, MD, FAChPM, Associate Professor of Medicine University of Wisconsin, Director, Pain and Policy Studies Group.
This policy and educational brief is a product of the Pain Action Alliance to Implement a National Strategy (PAINS) and the Center for Practical Bioethics.

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One thought on “An Important View on Pain as a 5th Vital Sign”

  1. rakiethebird says:

    I was born into a pre-vaccine polio epidemic and contracted a sub-clinical case of polio as an infant. During those dark times, many parents/doctors broke the law by not diagnosing to prevent infants from being warehoused in quarantine where death rates soared due to inadequate care as much as the disease. As a result, there were many victims, now in their 60s and 70s who endured a lifetime of pain and nerve degeneration. My Post polio syndrome along with degenerative disk disease, scoliosis, severe OA and fibromyalgia were diagnosed only when I turned 50. Despite living the stigma of pain and being a “drug seeker” for decades, I was able to live a more-or-less “normal” life until my pain became too much to bear. Since then, I have continued on a low but chronic controlled regimen of narcotic pain management therapy which has allowed me to remain productive and develop benefits that will be cost-neutral to society in my retirement. Nevertheless, society labels me an addict in the current “opioid epidemic.” Because patients in my situation are easily trackable through medical records, we end up being an easy statistic for claims of success in the “war on drugs.” But what is seldom talked about is the blowback to “catching” us and denying us pain control. Many of us are cut off -“cold turkey” by bullied health care providers who make the situation worse by not offsetting the suffering and harm of detoxification with treatment. This can and often results in death. Patients denied effective pain control can no longer work. So they lose their jobs, benefits, housing, etc… or turn to illegal means of procuring what had formerly been legal. Ironically the “cure” ends up costing society a lot more than the “problem.” Additionally, we are denied safer, effective and even less costly therapies, such as medications based on THC, that have been “banned” in our society for no credible medical reason while costly less-effective formulations are offered by pharmaceutical companies to those who can afford them. This brings doubt as to the intentions and veracity of this “war on opioids.” Is it really more about increasing BIG PHARMA profits without providing any real alternatives to patients in chronic pain? As America continues its descent into a corrupt society of pure greed and rule by corporatocracy, I rather think so. So, to all the experts who do not experience life with unrelenting soul-sucking pain but feel perfectly comfortable condemning millions to that fate, we would like you to know that we do not believe in your goals, your methods and intentions. We see YOU as our greatest barrier to our 1st Amendment right to “life, liberty and the pursuit of happiness.”
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