Pain is not a "vital sign"

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Specializes in ED.

There, I said it, now let the collective nursing/medical community rain fire upon me. I'm sorry, but I refuse to accept the idea that pain is a vital sign. I vital sign in a physiological response that is measurable, comparable and deviations represent a serious disruption of homeostasis. Pain is a subjective sensation felt in response to injury. The pain scale we use is useless for traditional "vital sign" purposes. I can't tell you how many times I've triaged a person with 10/10 belly pain while they sit there and eat McDonalds/doritos in front of me. I've never seen a person with a fever of 105, a HR of 180 or a RR of 40 sit there and eat McDonalds. The fact is that pain is far too subjective to be considered a "vital sign". VS are used to assess a patient's physiological condition, and are compared with normal ranges of known, universial numbers. That doesn't mean that pain is not important, because it is a useful tool. The pain scale can be used to asses the efficacy of treatment, but I don't think it's a good indication of homeostatis. For example, I once had a woman who was in a fairly minor car accident and had 4/10 side pain but she said she had a high tollerance for pain. Her spleen was ruptured. Yet our McDonalds friend is still in 10/10 pain. Without a frame of reference, the pain scale tells us little. There are a lot of other things that deserve to be a vital sign before pain does, such as pulseoximetry or blood glucose level. We care if our pt is in pain, but it should not be considered a VS... just my thoughts.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Perhaps time in a post surgical unit or an oncology floor may widen your horizons. Your perspective is based on one area alone.

Please consider going through a PACU, post transplant area, or even a CVICU and see if you still feel the same way.

Something tells me you may change some of your beliefs or perhaps be a little less judgemental.

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Specializes in ED.
Perhaps time in a post surgical unit or an oncology floor may widen your horizons. Your perspective is based on one area alone.

Please consider going through a PACU, post transplant area, or even a CVICU and see if you still feel the same way.

Something tells me you may change some of your beliefs or perhaps be a little less judgemental.

I'm not saying that pain isn't important, and I'm not saying that post-surgical patients don't have pain. I know, I've had surgery. However, I don't think we should call it a "vital sign" because there is no measurable frame of reference.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
I'm not saying that pain isn't important, and I'm not saying that post-surgical patients don't have pain. I know, I've had surgery. However, I don't think we should call it a "vital sign" because there is no measurable frame of reference.

That is why I am saying you should do some time in a PACU. There are definitive signs besides just the other "four vital signs" that indicate a patient is in pain, albeit subtle. Your experience alone, although helpful, isn't enough. It would be a good thing to see the whole gamut of it all. Do consider it--it is an excellent experience.

Pain is indeed a 5th vital sign--and again, I can say this without hesitation, pain is what the patient says it is. Also depends on how the care provider explains it too.

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I really see no point to this post.

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Specializes in onc, M/S, hospice, nursing informatics.
I really see no point to this post.

It's just going to turn into one opinion vs. another opinion. In the end, it is what our employers say it is.

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The pain is measured by a subjective patients' report. Scale of pain 1 - 10. There...that's measurable ;) I think pain should be considered a vital sign for nurses anyway..whether it's taught in school or not. I consider how much pain my patients are in to be "vital" information.

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ouch...jamesonson.:argue:... is this not the place for nurses to come vent and/or state their opinions.

mickeybsn states some very valid points. he never said it wasn't important to assess pain, he simply stated "it shouldn't be a "vital" sign since it is subjective.

some will agree, some won't. either way, i love your postings mickeybsn. :redpinkhe

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Specializes in Trauma, Teaching.

Well, I guess it could be considered a "vital" sign, since only "vital", as in alive, patients report it.......

I just think of it as an assessment to do along with the rest of my assessments, of which VS are only a part.

I think of it as a relative scale, but if you start off with 10/10, I guess you can't tell me it got worse! :chuckle

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The pain is measured by a subjective patients' report. Scale of pain 1 - 10. There...that's measurable ;) I think pain should be considered a vital sign for nurses anyway..whether it's taught in school or not. I consider how much pain my patients are in to be "vital" information.

I agree !! :yeah:

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Specializes in ER, ICU, Flight.

True, in your example of McDonald's man vs spleen rupture the pain scale was not very useful, but your comparing apples to oranges. The same could be said for HR, a athlete may be fine at mid 40s while others could be syncopal at the same rate. The differance is the context and the type of patient. No single vital sign gives you a hard fast understanding of a patient's hemodynamic status without more assessment. I have seen patient who live at a BP that would have me floored.

Pain as a vital sign is very important in cardiac patients for example. Did nitro relieve the pain? How much did it relieve the pain. This info is as critical as any other measurement. Is the persons pain changing over time? The McDonald's man may say 10/10, but what if they tell you a hour later is 20/10 (and they even put the fries down)? What changed?

Pain scale is without question very subjective, but the information, within context of your assessment and other vital signs, can be a crucial aspect of the triage process and continuing nursing care.

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Specializes in Surgical Acute Unit (Bariatrics & Ortho).

They do teach it as the "fifth vital sign" in school. But I think that the connotation is similar to the "sixth sense". Of course you only have five senses, of course you only have 4 vital signs, but there is this extra one that we are going to call a vital sign because it is really important to assess. They put it right up there with the other 4 because they don't want you to forget how important it is. Whether you agree that the "6th sense" is important is subjective.

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