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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