Pain is a Symptom; Not a Sign!

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Pain is a Symptom; Not a Sign!

My PERSONAL belief is that the campaign entitled, “Pain is the fifth vital sign,” is at the root of this country’s current, tragic, opioid epidemic. This approach was grossly misguided – at best!  Firstly, signs tend to be objective, whereas pain is subjective. Secondly, the words “vital signs” literally mean “signs of life” or “signs of being alive.” For millennia, the very evidence of a person being alive depended on: temperature, pulse/heart rate, and respiration. Later, upon the invention of the sphygmomanometer, blood pressure was added as a fourth vital sign.

What do these traditional vital signs all have in common? They can all be objectively quantitated (even in the unconscious) and need to be greater than zero for continued living. In stark contrast, pain levels are quite subjective, and a level of zero is not at all incompatible with life. Indeed, a zero pain level was the stated goal for the entities pushing the “pain is the fifth vital sign” nonsense. The people and organizations behind this campaign chastised physicians for “allowing patients to be in pain” by not prescribing narcotic medication in sufficient strength or quantity. They ardently advocated for complete elimination of pain at all times through pharmacologic means, and implied physicians who did not were callous and uncaring about patient well-being.

This attitude was compounded by the emergence of physician and medical facility online rating platforms on which patients could give negative ratings if they felt they were not prescribed desired strength/quantity of opioids. However, the primary error was the effort to confuse a symptom as a sign. It is doubtless that some have profited considerably from this effort. Have those responsible behind that campaign been held accountable? Will they be?

Omer A Ilahi, MD
[email protected]

DISCLAIMER: Statements of fact and opinion are the responsibility of the authors alone and do not imply an opinion or endorsement on the part of the officers or the members of WOA unless such opinion or endorsement is specifically stated. Materials may be reproduced only if Touches and the Western Orthopaedic Association are credited.


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