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Everyone knows the drill: within seconds of entering a doctor’s office for a routine check-up, someone sticks a thermometer in your ear, pumps up a blood pressure cuff, records your respiratory rate and takes note of your heart rate.
These are your vital signs; if any one of your vitals is abnormal it serves as an indicator that there may be an active illness or disease state present.
Although the four vital signs were the standard of care for decades, in the 1990’s, level of pain was added as the fifth as part of a Veterans Administration initiative and became a Joint Commission standard in 2002. One problem at the outset with this movement is that pain, which is subjective, was referred to as a “sign.” Signs on the other hand, can be measured objectively, like the four original vital signs in medicine. If a thermometer indicates that the temperature is 96, then that’s what it is.
Regarding pain, the patient reports subjectively a number to rate their experience of it, typically between one and ten. Unfortunately, instead of taking the appropriate steps to determine the underlying cause of the pain or considering other alternatives, many doctors simply write a prescription for opiates; they do so without informing the patient, or even being aware themselves, of the risks involved with taking pain medication.
It has long been believed that this subjective assignment to pain and the doctor’s willingness to supply opiates is a contributing factor in today’s epidemic of pain killer abuse.
The American Medical Association (AMA), our nation’s largest medical society, seemingly agrees and now recommends dropping pain as a vital sign.
To its credit, the organization admits to culpability in this nationwide problem, saying physicians played a key role in starting the opioid epidemic by overprescribing pain medication, and now must do their part to end it. Another large piece of the problem is the lack of addiction training in medical schools and residency training programs across the country.
By improving physician training, improving prescribing practices, raising patient awareness through honestly describing risks and benefits of pain medication in the informed consent process, we can positively impact the opioid epidemic that is killing hundreds of thousands of Americans unnecessarily. Moreover, we can do so in a way that protects access to opioid pain management for those people for whom these medications are truly appropriate.
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