Is pain still the "5th Vital Sign"?

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    I believe that when we went to using pain as “the 5th 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?
    Joe V and Altra like this.
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  4. 21 Comments so far...

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    I still consider it the fifth vital sign, because you'd be surprised how many people WON'T volunteer that they're in pain...often because they don't want to seem like a bother, they don't want to be labelled a drug-seeker, or are trying to "tough it out." I feel that asking about their pain gives them an opportunity for them to tell me about it without feeling like they're imposing on me. I think it also reassures them that they don't have to try to be heroes and suffer in silence.

    Even on the days in outpatient, it's become my habit to ask about pain as I put the cuff on their arm.
    SoldierNurse22 likes this.
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    BP, HR, RR, SpO2, Temp. I count 5 there. I don't think of pain as a vital sign. It's an assessment. An important one, but an assessment rather than a sign. As far as encouraging drug abuse, all the current research I've seen on pain management suggests that other factors are in play when it comes to addiction and that we are often still under-treating pain (particularly in peds).

    I'm still surprised how many patients won't mention anything about pain or discomfort until asked directly if they have any.
    turnforthenurseRN likes this.
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    I thought pain was the "6th vital sign" but either way, I do ask.
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    Oops, I agree, it would be the "6th Vital Sign" now that I think of it. I guess I am showing my age, because way back when the "pain campaign" started, sats were not done routinely.
    Thank you for setting me straight.
    I have to agree with hiddencatRN that "pain level" is part of an assessment. Pediatric patients probably are grossly under medicated and well as the dying and elderly. This is where an astute nurse is worth his or her weight in gold. Assessment and observation are key in pain management/intervention for patients.
    My concern is when we are focusing solely on a patients subjective report of pain and chasing that with (narcotic) medication. When patients report pain levels of 9-10 while eating and talking on the phone, we have to wonder if self-reporting has been watered down.
    Accidental overdoses happen this way. I know personally of more than one.
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    Yeah, I was just about to say it is still taught as the sixth vital sign with respirations, 02 sat, temperature, blood pressure, and pulse rate being the other signs. And yeah, a nurse should always as if the patient is in pain and to rate it. As a PCA/SNA, I ask if they are in any pain and to rate it so that I may inform the patient's nurse promptly.
    SuzieF likes this.
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    When I was a new grad, we didn't use Sp02 as a routine vital sign, so pain *was* the fifth vital sign. We checked Sp02 per our judgement.
    Soon2BNurse3, Meriwhen, and SuzieF like this.
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    Quote from hiddencatRN
    I'm still surprised how many patients won't mention anything about pain or discomfort until asked directly if they have any.
    I've noticed this too. I had a patient go into non-sustained v tach, so I went to check. The patient was awake but sleepy. They said they are okay, but as soon as I asked if they are experiencing chest pain, they say to me, "now that you mention it, I am having chest pain!"

    Regardless, a nurse should always assess a patient for pain. I was taught it was the 6th vital sign in nursing school, but I consider it more of an assessment rather than part of the vital signs.
    SuzieF likes this.
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    Quote from OneLoveNurse
    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?
    I agree that medical culture has changed. It is now the goal, and the expectation, for patients to be pain-free. This is a very different concept than that of pain control.

    Outpatient prescribing for self-limited conditions/injuries is out of control, as is acute care administration of IV narcotics.
    Bezoars and Ir15hd4nc3r_RN like this.
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    Quote from Altra

    I agree that medical culture has changed. It is now the goal, and the expectation, for patients to be pain-free. This is a very different concept than that of pain control.

    Outpatient prescribing for self-limited conditions/injuries is out of control, as is acute care administration of IV narcotics.
    As a post op nurse, I find this incredibly frustrating. Most people understand that it's impossible to be entirely pain free after having major surgery but some people just don't get it. I send a lot of time doing patient teaching on pain management, stressing the fact that it is management not elimination. On the other hand, I also stress the importance of evaluating treatment and if the pain control regimen we're using isn't working, I'm happy to call the doc.
    Zombi RN, Ir15hd4nc3r_RN, and Altra like this.


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