| One-Minute Clinician

The 5th Vital Sign and Pain Scores

I think we have to go back to before a lot of these scores, before the fifth vital sign was pain management. How did we treat patients before we had all these medications, interventions, surgeries at our disposal that were meant to help pain. I think a lot of what we're applying to chronic pain management has been evolved from acute pain management, such as through our anesthesia colleagues. We're applying a lot of the same principles to a disease process that is more global than just focal. I think eliminating pain as a fifth vital sign or from HCAHP scores is only going to be beneficial because then we release that back and see the bird's eye view in how to treat this in a more comprehensive manner than just by a numbers game. We've been spending a lot of our careers just saying "How do I get that pain score down?" And when we medicate it, we're finding the caveat to be true: we're actually inducing pain such as opioid-induced hyperalgesia, tolerance to certain medications, and we're hitting a wall with a lot of our conventional treatments. Those treatments come from the acute pain management philosophies. They don't really translate into when patients have pain for greater than 3 months.

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