The Fifth Vital Sign
Pain management is considered such an important part of care that the
American Pain Society coined the phrase “Pain: The 5th Vital Sign” (Campbell,
1995) to emphasize its significance and to increase the awareness among health
care professionals of the importance of effective pain management. Documentation
of pain assessment is now as prominent as the documentation of the
“traditional” vital signs. Pain assessment and management are also mandated by
the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
(2003).
Calling pain the fifth vital sign suggests that the assessment of pain
should be as automatic as taking a patient’s blood pressure and pulse. The
JCAHO (2003) has incorporated pain and pain management into its standards.
JCAHO’s standards state that “pain is assessed in all patients” and that
“patients have the right to appropriate assessment and management of pain.”
These stan-dards reflect the importance of pain management.
In health care, the primary care provider’s role is to assess and
ameliorate pain by administering medications and other treat-ments. The nurse
collaborates with other health care profession-als while administering most
pain relief interventions, evaluating their effectiveness, and serving as
patient advocate when the in-tervention is ineffective. In addition, the nurse
serves as an edu-cator to the patient and family, teaching them to manage the
pain relief regimen themselves when appropriate.
The International
Association for the Study of Pain definition mentioned earlier encompasses the
multidimensional nature of pain (Merskey & Boduck, 1994). A broad
definition of pain is “whatever the person says it is, existing whenever the
experienc-ing person says it does”. This definition emphasizes the highly
subjective nature of pain and pain management. The patient is the best
authority on the exis-tence of pain. Therefore, validation of the existence of
pain is based on the patient’s report that it exists.
Although it is important to believe the patient who reports pain, it is
equally important to be alert to patients who deny pain in situations where
pain would be expected. A nurse who suspects pain in a patient who denies it
should explore with the patient the reason for suspecting pain, such as the
fact that the disorder or pro-cedure is usually painful or that the patient
grimaces when mov-ing or avoids movement. Exploring why the patient may be
denying pain is also helpful. Some people deny pain because they fear the
treatment that may result if they report or admit pain. Others deny pain for
fear of becoming addicted to opioids
(pre-viously referred to as narcotics) if these medications are prescribed.
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