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    Pain is not the fifth vital sign

    After years of exaggeration, misinformation and a national epidemic of opioid and heroin abuse, the nation is finally coming to terms with the fact that pain is not the fifth vital sign. This heresy, as I understand it, has existed for close to three decades and, in my opinion, has been directly responsible for the in hospital deaths of thousands of patients as well as lethal drug overdoses of hundreds of thousands of American citizens through illicit opioid use.


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    The misguided acceptance of pain as the fifth vital sign has been, and still is, the single biggest mistake in the history of modern medical pain management.

    In the early ‘90s, the American Pain Society opined that there was a national epidemic of untreated pain in our nation’s hospitals and announced that pain should be classified as the fifth vital sign. This assertion is riddled with many problems. Vital signs are clinical measurements, specifically: pulse rate, temperature, respiration rate and blood pressure, that all indicate the state of a patient's essential body functions.

    These clinical measures are very objective in character and include an assortment of relevant numerical values. Pain is a subjective feeling that is impossible to accurately and consistently quantify across patient populations. Therefore, in order for providers to assess pain as a vital sign, they must ascribe a numerical value for it, such as zero to ten based on the Universal Numeric Pain Scale.

    As a result of equating pain as a vital sign, medical practitioners must come up with a reliable and effective treatment if and when a patient subjectively rates their pain high on the scale.

    In 1998, the Federation of American Medical Boards issued a policy reassuring physicians that “in the course of treatment,” large doses of opioids were acceptable. In 2001, the Joint Commission mandated that hospitals across the country assess pain on each patient they treat.


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    While not stating how facilities should assess pain, the nation relied on what the prevailing though was: pain should be considered the fifth vital sign and treated on the zero to ten pain scale. With the support of the Joint Commission, The Federation of American Medical Boards urged individual state medical societies to make the under treatment of pain punishable for the first time.[1]

    With misinformation and external pressure by state and national oversight agencies, American hospitals and medical professionals were steered toward the over treatment of acute and chronic pain. Failure to comply was tantamount to patient abuse and battery, punishable by citations from medical boards and the Joint Commission.

    Next: "We must bury the claim of pain being the fifth vital sign"

    Myles Gart MD
    Myles Gart, MD, MMM, is a member of the ASA Committee on Professional Liability, president and CEO of gartmd.com and a practicing ...


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    • [email protected]
      I find it interesting that each time I change pages within this website, including on this article, there is a pop-up ad for Nucynta. Tell me more about the opioid crisis!
    • UBM User
      "First and foremost, we must bury the claim of pain being the fifth vital sign and replace it with a 21st Century pain assessment tool that incorporates objective evidence and measures of pain." Dr Gart, at this moment are you hungry? In your lifetime have you ever been hungry? Hunger is a type of pain. Did you treat that pain by consuming a substance? Please correct me if I am wrong. To my knowledge there is no objective test, no simple Pain Meter, that will show me that you are hungry. Yes we could look at enzymes and such. Will that truly tell me just how hungry you are objectively? If there is no objective test for a pain as simple as hunger, that each of us experience most every day, what hope does a person in Chronic Pain have? In Ohio the Governor is now practicing medicine by decreeing that there can be no more than seven days of opiate pain medication. Perhaps he should discuss that with the person that was hit by a train and survived with most every bone broken. My wife Karen *HUNG HERSELF* to stop the pain she experienced for over 20 years, due to the failure of the Medical Establishment as a whole. THIS IS THE REALITY OF Chronic Pain. "Karen's Journal of CSF Leak Headaches and Chronic Pain: How Intracranial Hypotension and Levaquin (Levofloxacin) Killed Me" is now required reading at Duke School of Medicine to educate future Neurologists about the realities of Chronic Pain. A local reporter wrote in a Cover Story: "Karen's first-hand account of her illness gave an honest, heart-wrenching depiction of what it is like to live with debilitating pain day-to-day." -- kpaddock DOT org [I don't know if this site allows links in the comments.] May I humbly suggest you read it. kpaddock DOT com/book kpaddock DOT com/fq for FDA links on the antibiotic issue. In book form it has been edited by a medical doctor that has the same condition has Karen had. When bought through the Spinal CSF Leak Foundation 100% of the royalties go to them, to support them, just in case anyone things I'm posting this to promote the book. The earliest draft of the book is found on kpaddock DOT com for free. I do not know what motivated you to write your article. I do know from it that far more time needs to be spent with people in Chronic Pain, to understand the realities of their life. When a person in Chronic Pain that has been taking opiate pain medication under a competent doctors supervision for ten years, is able to function, take care of their family, hold a job, is without warning told then can not have it any more, "tough luck". What are they to do? They resort to street drugs and become the very victims this currently policy is trying to prevent. People in Chronic Pain have typically already tried multiple rounds of physical therapy, bio-feedback, meditation, exercise and the list goes on, with no relief from the pain. What are they to do? Not having Chronic Pain myself, I will never claim to understand it. I did watch my wife suffer with it for 20+ years. What exactly is the agenda here? None of us such as Advocates like myself nor the sufferers have figured this out yet. Can anyone please explain? To us it appears as an attack on the most venerable. This is one of the many comments I received about your article: "...Chronic problems frustrate doctors and they blame the patient rather than look at themselves. ..." or support research to find real solutions to Chronic Pain. No one chooses to live with Chronic Pain each and every moment of their lives. Ad Hominem attack in 3...2...1
    • UBM User
      I love what the site does to line spacing. :-(
    • [email protected]
      This began with JCAHO/TJC. The opioid crisis started the year they mandated this. Now, 27 years later, they apparently recognize it and are backtracking, moving away from pain as the 5th vital sign.

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