Pain as the Fifth Vital Sign: Exposing the Vital Need for Pain Education

Abstract

In clinical practice pain as the 5th vital sign has proven to be more complex to assess, evaluate, and manage than originally anticipated. It has also had some serious consequences which were never intended. Associated with the national push to adequately manage patients in pain has been a rise in prescription opioids as well as a rise in opioid related death. Guided by pain as the 5th vital sign mandates, patients report pain and expect their providers to respond. Many clinicians do not know what the appropriate response is because they lack adequate education in the approach, examination, and management of patients in pain. Pain education starting in medical school and through postgraduate training usually involves piecemeal incorporation of pain topics into existing curricula or clinical rotations, without devoted stand-alone class-time. The net effect has been a serious deficit in clinical skills for the evaluation and management of the patient in pain. When both patients and clinicians view pain as purely a sensory experience then management is necessarily limited to managing the sensation (and the increased prescription of pain medications). This is likely to result in a suboptimal patient response, especially when managing chronic pain. Pain evaluation and management is further complicated in the older adult who requires a different approach to take into account comorbidities, including dementia, and increased adverse consequences of prescription medications. Expanding pain education and training is critical to remedying these problems. Attention must move beyond the focus of pain as a 5th vital sign to a focus on education and training in the evaluation, examination, and management of the patient’s pain report.

A Cross-sectional Feasibility Study Testing the Use of Abstract Animations for the Communication and Assessment of Pain (Preprint)

“…[29] In fact, this initiative may have contributed to the rise in opioid prescription. [30] The 0-10 scale has not improved pain assessment or treatment because the scale is unidimensional, uninformative, and lacks utility for both patients and their medical care providers. [9] Painimation provides an opportunity to collect the same data in a shorter time frame.…”

Neurobiological studies of chronic pain and analgesia: Rationale and refinements

“…In January of 2001, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) established a new mandate that pain be considered a vital sign (Lanser and Gesell, 2001); this concept was initiated in the mid-1990s by the leadership of the American Pain Society (Campbell, 1996) through an extensive educational campaign to require health care professionals to assess pain level in all patients in the same manner as temperature, blood pressure, pulse, and respiratory rate (Lanser and Gesell, 2001) and provide treatment. Expanding pain assessments has since greatly raised awareness of the prevalence of pain, while simultaneously uncovering the challenge of how to effectively and safely manage pain (Morone and Weiner, 2013).…”

Оцінка Больового Синдрому У Дітей. Сучасний Стан Проблеми

“…Ми повинні навчати лікарів і медсестер трактува-ти біль як життєву ознаку. Якість допомоги поля-гає в тому, що біль потрібно вимірювати та ліку-вати» [5].…”

“…Нами було проаналізовано ряд європейських та американських керівництв щодо ведення больового синдрому в дітей з метою відбору найбільш ефек-тивних інструментів оцінки болю в дітей, а також спроби систематизувати підходи в оцінці болю в ді-тей [2, [4][5][6][7].…”