Is pain still the "5th Vital Sign"?

[SuzieF]

I believe that when we went to using pain as "the 5^th vital sign" and began to routinely use a pain rating scale such as "0 to 10", we watered down the effect of self-reporting with a large portion of our patients. I also believe that it has led clinicians overmedicating countless patients.

I am sure that the original "pain campaign" probably originated with evidence-based research. It would be interesting to now see the data of how prescription drug dependency has changed in the last decade after the "pain campaign." I was a newer nurse when it all started, but I don't remember seeing as many medication dependent patients before then.

I am just wondering what you guys and gals think?

[netglow, ASN, RN]

I agree with the OP. While patients should be assessed for pain, the "asking" so frequently about pain, is one of the questions on the survey the patient will receive in the mail... soon these things will be part of reimbursement contingency. Administration is not concerned for the patient's well-being here so much - it's about survey scores and and filling out things involved with Meaningful Use tabs on the EMR.... revenue generators.

[Aurora77]

Wow, Ashley, that is crazy. I would have to question a nurse that thinks that amount of dilaudid is going to hurt your healthy husband.

On the same note, why in earth would any doc think dilaudid will last 6 hours?? I give it a lot (I work post op) and in the vast majority of cases it's 1.5 to 2 hours max. We're so terrified of creating dependance that we undermedicate for pain. It's sad.

[Double-Helix, BSN, RN]

Aurora, I wondered that myself. And once he got admitted to a floor I spoke to the nurse about it and we got the frequency changed- to 4 hours. It was a very frustrating experience. He, in my opinion, needed a PCA since he was on the add-on list for a cholecystectomy and it was over 16 hours before he could be brought into surgery. If I didn't hate what Press-Ganey is doing to hospital systems, I would sure have something to say when we get the survey.

[MunoRN, RN]

I agree that HCAHPS (referred to as Press-Ganey) is a bit of an abomination, but I hate to see that cause us to turn on everything in the survey. The purpose of good pain control actually has very little to do with patient satisfaction. Proper pain control initially actually reduces overall opiate use during an illness and recovery (those who realize we can't be trusted to adequately control their pain will take this responsibility on themselves, becoming what we then call "drug seekers", even though most of those folks are better described as "adequate-care-seekers"). Patients with sufficient pain control also have better outcomes, both short and long term.

[Bezoars]

I think most doctors prescribe way too much pain medicine. These patients think that at the first twinge of "something" they need dilaudid. The big zero pain tolerance of the 70's has ruined this country. All pain cannot be controlled. I always tell my patients the goal of reducing/making managable your pain... not taking it away completely. Working on a mother baby floor right now and occasionally I will have a mom who just had a lady partsl delivery ask for Perc 10's. Um, I don't think so. We have created a lot of the drug problem our society has with our no-pain-should-ever-be-felt attitude. It's just not right.

[Double-Helix, BSN, RN]

I think most doctors prescribe way too much pain medicine. These patients think that at the first twinge of "something" they need dilaudid. The big zero pain tolerance of the 70's has ruined this country. All pain cannot be controlled. I always tell my patients the goal of reducing/making managable your pain... not taking it away completely. Working on a mother baby floor right now and occasionally I will have a mom who just had a lady partsl delivery ask for Perc 10's. Um, I don't think so. We have created a lot of the drug problem our society has with our no-pain-should-ever-be-felt attitude. It's just not right.

I'm just curious, have you ever delivered a baby? Ever had a third or, god-forbid, fourth degree laceration? If anything warrants Percocet, that does. Unless you know exactly how much pain they are in, you shouldn't be judging them. That's exactly the reason why people fail to report their pain- they are afraid that they will be thought weak, called drug-seekers, and otherwise judged.

I really disagree that the health care system has "created a lot of the drug problem" by adequately managing pain, and I don't believe that the majority of people who are abusing narcotics (please note the difference between dependence and abuse) are doing so because they are trying to eliminate their pain.

[Rhi007]

I'm one of those nurses that will ask about pain but when it comes to myself I have to be vomiting from subarachnoid irritation due to pain before I say anything.....plus you can normally tell by looking at a patient

[boggle, ASN, RN]

With the "pt satisfation scores" emphasis put on pain rating and relief, I feel we are pressured into the quick fix ( no pun intended) of pain meds. We are rushed as it is...now also pressured about how the floor rated this month. With that pressure, I see less time spent, ( less time available too), on other measures to control pain and increase pt comfort. Pain is real, but made worse by fear, anxiety, muscle spasms, ..... I long for the time to stay a minute or two with a pt, after medicating, to reassure, to teach and explain what effect to expect, to see if adjusting position would help, and all those other measures that really lead to a comfortable pt, and a Satisfied Customer.

Chronic pain is awful. A person's own goal may be to get down to a 3/10. At a 6/10, you may not see a wince or frown. You can't judge by the way they look. Just listen to your pt please, even if they don't look like that frowny face on the pain scale page.

I know I am much more emotive, emotional when I have acute pain then when dealing a chronic pain issue. Acute pain...I get scared and feel vulnerable. When in acute pain, i get the eye roll, she's overacting look. When my chronic pain becomes an issue, i get the skeptical look and questions. I don't show that pain much.

Don't take it personally. Just treat the pt. Thanks for letting me vent a bit here.

[BrandonLPN, LPN]

The beauty of the 5 traditional vital signs (plus SPO2) is that they're 100% objective data.

Pain, on the other hand, is purely subjective.

Pain is important, but not a true vital sign.

[Nurse_]

It's still the 6th vital sign.

Why?

If a patient is in pain, their HR, RR, and BP can be affected. If you solve the pain issue, you'll get a better picture of what the patient is really going through.

Overmedication?

I follow my assessment and doctor's orders. Does it mean overmedication? Not necessarily. If I gave the patient their PRN and they don't exhibit any adverse effect, does it mean I overmedicate them?

Bottomline, nurses are there to assess and evaluate, to relay to the doctor that the treatment is too little or too much. How can it be then that a doctor can overmedicate when it is still nurses who administer the medication?

[nurseswholovenursing]

I do believe that ALL pain can and should be treated, especially in an acute care situation. It is my job, and I did not need 10mg percocet post delivery, but thats me. But some woman do. I took care of a 88 y.o.woman who weighed about 80 lbs, and she had bone cancer as her primary, and it was everywhere else. She would lay in her bed, avoiding any movement, it probably hurt her to blink: She only wanted "aspirin" for her complaints of pain of 3/10. She never took narcotics. And my friend that has RA, and was literally crying and screaming, because she had a flare, that was the worst in her left thumb, which she decribed as being stabbed in that joint by a broken butter knife, for which she was precribed dilaudid 8mg q 2 hours by her rheumatologist, which kept her from jumping off the roof of her house. I tried to educate the 88 y.o. on pain, and we all tried to talk her into narcotics, but in the end, it was her death, her pain, and she knew how she wanted to leave this world. And i have taken my friend to the pool, given her tons of exercises for flexibility, but when she has a flare, the dilaudid is close by her, because she also knows what she can and can not handle. It is not for me to judge. Medical education, as far as mine anyway, didn't give me any insight to know what anyone needs. Only gave me the ability to properly educate, and to include my pts. In how, and with what, we treat them. If I worked in OB, and a woman asked me for 10mg of percocet post delivery, after I did a pain assessment, I would have called the doc and would have got her an order for just that, but that's me.