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.
:yeah:I agree with what has been said and when I do vital signs I also chart pain and use the pain scale in our facility rated 1-10. I have seen residents that run elevated temperatures, heart rates, respirations, and blood pressures because of pain. When you chart your vital signs and then pain as 1-10 this also gives a rational as to why one or all of the vital signs are elevated if no other symptoms are present. It is amazing then if the resident is having pain and a PRN analgesic is given you will see a decrease in the other vital signs.
When I see that people "brush off" pain on pre-judgments, it's a slippery slope. I truly believe it is better to err on the side of believing the patient rather than not--even if the patient has an IQ of a banana.
My current area of practice is chemical detox, where I can have anyone from a nice and simple alcoholic to IV opioid plus anything else under the sun they could get their hands on. I don't believe that anyone has said that pain is not important, but it can be abused by those that are drug-seeking. Having previously worked in oncology, my view of my patient's pain was entirely different, and so my actions were different. I just find that some of this fellow nurse-bashing not helpful or kind. Where is staff??? --they normally are the ones that are telling us all to keep it civil and above-board.
I think that one can make a logically sound argument that pain is not a vital sign.
However, it was said to be a "fifth vital sign" so as to assess it as much as you would the other vitals. Pain affects your ability to function. Ask anyone with chronic back pain like my mother for instance. Her pain affects her just as much as her high BP. Pain is just as important to assess as the other vitals.
Now, I absolutely agree that pain, for the most part, is subjective. Using my mother again for example, her pain threshold is higher than someone who doesn't live with pain on a daily basis. Johnny from down the street might pull a muscle in his back and rate his pain at an 8 or a 9, while my mother might rate that same sort of pain at a 4 or a 5 because she has grown used to it. Does it make my mother's pain any less significant? No, absolutely not.
But pain is also objectively measured. Facial grimacing is an objective measurement. Becoming tachycardic or diaphoretic dt being in pain is also another objective observation/measurement.
You don't need to buy into that pain is the 5th vital as long as you are giving it due consideration and assessment.
I have worked where none of my patients was able to verbally tell me if they were in pain or not. Yes pain can be a subjective measure but it can also be an objective measure. Facial grimacing, restlessness, increased behaviors, all can s/s pain. VS i don't know, but a definate important part of the assessment.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
pain is what the patient says it is.
Too many doctors and nurses put their subjective and very personal opinions and biases about pain right smack dab in the middle of people's healthcare. This means that the guy who says he has pain 8/10 but doesn't behave the way the nurse thinks he should be behaving will not likely be taken seriously. That translates into being dismissed and undertreated. Are there people who are drug seekers and who are out for a high? Certainly. I would suggest that there are more people who are denied adequate pain control because of the fears and biases of healthcare professionals than there are people who are actually abusing the medications. The truth is that the average PCP is not well versed in and not very comfortable with the management of on-going pain issues. It is no wonder then that there are scores of people who have undertreated pain. This pain affects EVERY ASPECT of their daily life. They learn to LIVE with it, but they would like to have it controlled. They are viewed as drug seekers and hypochondriacs by too many health professionals. How long has he had the pain? If his pain is chronic it is no surprise that he can eat while experiencing pain. Chronic pain is no less important than acute pain. Chronic pain often presents itself to the healthcare professional with fewer changes in the VS than does acute pain...these people are adapted. THAT DOES NOT MEAN THEY DO NOT HAVE REAL PAIN.
Is it a vital sign? ...call it what you want...it is as important an assessment as breath sounds, heart tones, or bowel sounds. It can be quantified and qualified. It can be assessed in the nonverbal, demented, and pediatric client. The appropriate treatment of pain has a profound effect on the life of the patient and lack of treatment can have a tragic equally profounjd effect. Our model of traditional medicine has come a long way in understanding pain in the human patient but we have a long way to go. Do you remember the days when docs thought it was too dangerous to give pediatric patients opioids? Do you remember when they circumcized infants with no pain control? Do you recall when the common thought was that persons with fibromyalgia were just crazy? Or that phantom pain was "all in their heads"? We must be compassionate and thoughtful when considering a reported pain level. We do not want to be dupes but we also do not want to contribute to on-going medical neglect when it comes to chronic pain control. We must not allow ourselves to become so involved in finding and fixing the "problem" that we forget to take care of the symptom in the process. Pain is a symptom. Sometimes we cannot fix the problem that causes the symptom. Sometimes we are not even sure what the "problem" is but that does not mean that we should not treat the symptom.
Thank you for giving me the opportunity to regurgitate one of my passions as a nurse.
I agree that pain is not a vital sign, and I also agree that pain is whatever the patient says it is. However, I do not need to hand out narcotics like candy every single time that a patient says they have pain. Just because you have a headache doesn't mean that you need Dilaudid (says a long-time sufferer of migraines).
I tend to go by the looks of the patient when I am assessing pain. I do include their 1-10 pain score in my assessment, but I look at many other things as well - grimacing, vital signs, etc.
Stating that pain isn't a vital sign (it isn't) doesn't equate to dismissing it or diminishing its importance.
I agree with you, and appreciate your post. I do understand some of the other posters saying it isn't one of the other classic vs, and maybe it's just at our facility we get written up if it isn't documented right there with the other four.
Please don't flame me, I'm just saying that is what we have to do at our facility.
If that's the case, there are many assessments that can include the "measurable" cues. Yes, pain is subjective, but CAN--not always--be objective as well...i.e. facial grimacing, increased muscular tension, higher heart rate, etc.,
Dismissing it altogether is also a mistake.
Pain CAN BE both objective and subjective.
Pain can be JUST subjective.
Pain can be JUST objective (note: patients intubated, paralyzed for neuro/ARDS, high frequency vents, etc.,)
Pain is the 5th vital sign.
I highly recommend that those who do not believe that it is a 5th vital sign peruse or participate in a unit that relies completely on objective signals. (ICU, CVICU, NICU, OR--anesthesia providers base their pain management on "bucking" of the vent, increase in VS alone etc.,) to a unit that relies heavily on subjective details (PACU, chronic pain management, rehab etc.,).
It is a good way to learn that one's perspective is NOT the only way.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Stating that pain isn't a vital sign (it isn't) doesn't equate to dismissing it or diminishing its importance.
The OP was dismissive of the patient and judgmental. Which leads me to believe that in that logic, he will continue to make prejudgments on patients. I see many nurses do that. Blow people off and then realize later on when someone has seen the patient (much of it cultural) that there really is an issue that needs addressing.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
My current area of practice is chemical detox, where I can have anyone from a nice and simple alcoholic to IV opioid plus anything else under the sun they could get their hands on. I don't believe that anyone has said that pain is not important, but it can be abused by those that are drug-seeking. Having previously worked in oncology, my view of my patient's pain was entirely different, and so my actions were different. I just find that some of this fellow nurse-bashing not helpful or kind. Where is staff??? --they normally are the ones that are telling us all to keep it civil and above-board.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
I think that one can make a logically sound argument that pain is not a vital sign.
However, it was said to be a "fifth vital sign" so as to assess it as much as you would the other vitals. Pain affects your ability to function. Ask anyone with chronic back pain like my mother for instance. Her pain affects her just as much as her high BP. Pain is just as important to assess as the other vitals.
Now, I absolutely agree that pain, for the most part, is subjective. Using my mother again for example, her pain threshold is higher than someone who doesn't live with pain on a daily basis. Johnny from down the street might pull a muscle in his back and rate his pain at an 8 or a 9, while my mother might rate that same sort of pain at a 4 or a 5 because she has grown used to it. Does it make my mother's pain any less significant? No, absolutely not.
But pain is also objectively measured. Facial grimacing is an objective measurement. Becoming tachycardic or diaphoretic dt being in pain is also another objective observation/measurement.
You don't need to buy into that pain is the 5th vital as long as you are giving it due consideration and assessment.
THIS is exactly what I am trying to convey. Thank you.
Just because you have a headache doesn't mean that you need Dilaudid (says a long-time sufferer of migraines).
:yeah:
Shortcake123
6 Posts
:yeah:I agree with what has been said and when I do vital signs I also chart pain and use the pain scale in our facility rated 1-10. I have seen residents that run elevated temperatures, heart rates, respirations, and blood pressures because of pain. When you chart your vital signs and then pain as 1-10 this also gives a rational as to why one or all of the vital signs are elevated if no other symptoms are present. It is amazing then if the resident is having pain and a PRN analgesic is given you will see a decrease in the other vital signs.
Doris, RNAC