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.
Hmmm...I understand what you are trying to say, however, I am not sure how you justify that pain doesn't effect homeostasis. Pain certainly has physiological effects and causes stress to the body.
Nobody has stated pain doesn't affect homeostasis, least of all me.
Pain can delay healing and/or prevent wellness. Like other vital signs, pain can be an indicator of health or illness.
Unlike other vital signs, it isn't a vital sign.
Lots of things are indicators of health or illness: nausea, anxiety, appetite, mood, and so on.
They all affect homeostasis indirectly.
The key distinction is that while pain, nausea, anxiety, et al. affect homestasis, the vital signs are the objective manifestations of homeostasis.
Pain is not subjective...to the person that reports it...pain is a physiological response to a stimuli....just like you can have 10 people in the room that will have different heart rates, blood pressures, body temperatures, you will have people that will report varying levels of pain to the exact same stimuli.
It is measurable with proper assessement and reassessment and management.
We all don't have the same pain tolerance, pain experience, etc.
Pain can also estimated in patients that cannot speak, such as in the FLACC scale used with Neonates.
Excellent points. It can also be hard to assess pain in the elderly, especially those with Alzheimer's Disease or other conditions that result in dementia. Nurses must rely on non-verbal cues such as facial grimacing, alterations in movement or changes in behavior when persons with dementia cannot articulate that they have pain. I recently read an article on an online journal that said that health care professionals often underestimate the amount of pain experienced by those with dementia and that putting such persons on regular, scheduled doses of acetaminophen can decrease the occurrence of combative and other behaviors exhibited by some persons with dementia.
ETA: Oh, duh---the article was referenced here on AN. Here's the link to that thread:
Regarding the pain tolerance and pain experience issues: I have taken care of some people---often tough, stoic Scandinavian farmers---who have extremely high levels of pain tolerance. In a parish nurse research project, the principal investigator found that some of these stoic souls will ignore symptoms of an MI because their experience with pain has taught them to just work through any pain, no matter how bad it gets. At the other end of the spectrum, I always thought I had a high pain tolerance because, even if my back hurt, I didn't take anything for pain. Yet, every day I felt like my muscles ached as if I'd run a marathon and I sometimes my back and shoulders hurt so much after eight hours working on the floor that I wanted to just to cry. My hands hurt, my joints hurt, and I was convinced that either I had arthritis or some truly horrible CNS condition. The week of my fiftieth birthday, I was diagnosed with fibromyalgia, which, research is starting to demonstrate, is a CNS problem in which stimuli that might not be painful to some people are perceived as painful by those who are afflicted. After several tries with different medications, I am taking something that seems to work. But---having said that---I have also had several surgeries, including a cervical laminectomy and an emergency C-section---and none have been as excruciatingly painful in the recovery process as the removal of bone spurs from my little toe. A week after my surgery, when I had my stitches removed, I was in so much pain in spite of medication that I was bawling. On a pain scale of 1-10, with labor being a 10, my pinky toe pain was 9.5. It might not make a lot of sense to anyone else but it is what it is. My experience of pain was that this was excruciating and, maybe I am a wimp and a disgrace to my Scandinavian heritage, but doggone it, it HURT! If anyone can get through surgery without experiencing pain, kudos! I am envious! But please don't judge another's pain simply by comparing it with one's own experience. What might be a breeze to one person can be horribly painful for another.
And that's why nurses need to assess their patients for pain just as carefully and as frequently as they would check vital signs.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
The reality of pain is this...pain causes stress. Long-term exposure to stress can lead to serious health problems. Chronic stress disrupts nearly every system in your body. It can raise blood pressure, suppress the immune system, increase the risk of heart attack and stroke, contribute to infertility, and speed up the aging process. Long-term stress can even rewire the brain, leaving you more vulnerable to anxiety and depression.
I stand by my statement... I think that a person experiencing intractable 10/10 pain will have a shortened life span. I think that a person experiencing intractable 10/10 pain will ong to have a shortened life span.
Fortunately, most of us do understand that very abnormal VS are indicative of an untimely death, which is why we are pretty faithful about monitoring those things...pain, however, if often neglected in our nursing assessments across a variety of practice settings.
Seriously, I look at charts in hospitals and nursing homes, and assisted living facilities and I find that nurses are not good at documenting their pain assessments...even on patients who have known or anticipated pain issues. We can do better. It IS important. Don't call it a vital sign if you don't want...but do consider it vital to taking care of these people.
I can't believe this thread has gone on this long, but I guess I might as well throw in my two cents....
I think the original poster is taking the "vital" in vital signs to mean essential to continuing physical life. In checking several medical dictionaries this seems to be its traditional meaning.
There is another meaning of "vital," which has to do with something being crucially important in any area. I think this is the meaning that the "pain is the fifth vital sign" advocates are assigning the term. It is crucially important to assess pain.
My understanding of the original poster's concern is that the phrase "fifth vital sign" muddies the waters between the two meanings of "vital" and he worries that sloppy language may lead to sloppy thinking, a very valid concern.
The original poster also gives an example of how subjective pain assessments can be, and other posters have rightly pointed out that there are objective signs to be noted in pain assessments also and the importance of taking patient reports seriously. But I see the discussion of how to properly assess pain as something different from the OP's original concern about terms, and I think that has led to a lot of talking at cross purposes in this thread.
Just my take on matters. In my practice I see nurses assessing pain as often, if not more so, as they check traditional vital signs.
I stand by my statement... I think that a person experiencing intractable 10/10 pain will have a shortened life span.
Two things:
1) Citation please. Back this up with something.
2) Even if true, the key difference again is that while a patient might have their lifespan affected by intractable pain, a patient with vital signs significantly deviant from the mean may very well be clinically dead.
Do you see?
Pain affects homeostasis.
Vital signs are the objective representation of homeostasis.
It's a subtle but incredibly important difference.
I can't believe this thread has gone on this long, but I guess I might as well throw in my two cents....
I think the original poster is taking the "vital" in vital signs to mean essential to continuing physical life. In checking several medical dictionaries this seems to be its traditional meaning.
There is another meaning of "vital," which has to do with something being crucially important in any area. I think this is the meaning that the "pain is the fifth vital sign" advocates are assigning the term. It is crucially important to assess pain.
My understanding of the original poster's concern is that the phrase "fifth vital sign" muddies the waters between the two meanings of "vital" and he worries that sloppy language may lead to sloppy thinking, a very valid concern.
The original poster also gives an example of how subjective pain assessments can be, and other posters have rightly pointed out that there are objective signs to be noted in pain assessments also and the importance of taking patient reports seriously. But I see the discussion of how to properly assess pain as something different from the OP's original concern about terms, and I think that has led to a lot of talking at cross purposes in this thread.
Just my take on matters. In my practice I see nurses assessing pain as often, if not more so, as they check traditional vital signs.
This sums up the thread well.
It's like a giant straw man in here: one side is arguing the terminology used while the other side is arguing how important pain and how could we be so callous as to diminish its importance.
If pain's the fifth vital sign, I propose that anxiety becomes the sixth vital sign. Nausea the seventh. Appetite the eighth, affect the ninth, spiritual well-being the tenth, and so on.
After awhile the list will become so ridiculously inclusive it will look just as long as your shift assessment.
Oh wait, that's a eureka moment: they are already part of the assessment? How convenient.
Very few folks here have stated that pain is unimportant. Just because some of us don't think that pain is a vital sign doesn't mean that our patients' pain is not assessed and treated. I don't know how some of you are making that deduction.
It's no wonder that so many other professions don't take nursing seriously. Failure/inability to distinguish between subjective and objective data just makes us look like a bunch of amateurs. I highly doubt that any physicians or medical students are debating something like this right now. :chuckle
Not sure if this has been asked before. Have not read every post in this tread yet. Do you describe the pain scale to the patient like "what is your pain on a scale of zero to ten with ten being the worst pain imaginable like being ripped in half". People do have different pain tolerances...some are more stoic than others. I can have the same situation happen to me as well as my sister in law and I could be a 3 out of 10 and she would be a 9; she has a very low pain tolerance and on top of that is very vocal about her pain...but that does not mean she is in any more pain than I am.
But I do understand some peoples view of it not being a vital sign...one could argue..."people die of too low blood pressure, or too low pulse, or two low respirations, or too high or too low of a temp...all can signal one to what might be going on...no one has ever died of pain and it alone can not necessarily tell what is going on"
Pain alone on a number scale should not be a vital sign. But think of this...the character of pain such as a sharp pain in placenta abruptio or DVT, different characters of pain that signal a heart attack.... isn't this why we are suppose to ask the character and not just the number on a scale? That would be a vital sign to me
Not sure if this has been asked before. Have not read every post in this tread yet. Do you describe the pain scale to the patient like "what is your pain on a scale of zero to ten with ten being the worst pain imaginable like being ripped in half". People do have different pain tolerances...some are more stoic than others. I can have the same situation happen to me as well as my sister in law and I could be a 3 out of 10 and she would be a 9; she has a very low pain tolerance and on top of that is very vocal about her pain...but that does not mean she is in any more pain than I am.
But I do understand some peoples view of it not being a vital sign...one could argue..."people die of too low blood pressure, or too low pulse, or two low respirations, or too high or too low of a temp...all can signal one to what might be going on...no one has ever died of pain and it alone can not necessarily tell what is going on"
Pain alone on a number scale should not be a vital sign. But think of this...the character of pain such as a sharp pain in placenta abruptio or DVT, different characters of pain that signal a heart attack.... isn't this why we are suppose to ask the character and not just the number on a scale? That would be a vital sign to me
Very well said. I believe this is one of the better explainations I have heard so far. Whether or not it is a vital sign, pain should always be a part of our patients assessment. Excellent post!!!!
I think that the vital part is that pain MUST be taken into consideration during an assesment. Yes, everyone's perception is different, but, until a better "tool" for measuring comes up, 1 to 10 is what we've got...
Apparently I must back up what I have clearly identified as my opinion with a citation?
I have annoyed hypocaffienemia. Ah well.
Oh, I'm not annoyed. I just find opinions of little merit unless backed with reality. You're free to believe what you want, but without any sort of factual backing, why should I believe it any more than if you were to state that mashed potatoes and gravy causes blindness?
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hypocaffeinemia, BSN, RN
1,381 Posts
Nobody has stated pain doesn't affect homeostasis, least of all me.
Unlike other vital signs, it isn't a vital sign.
Lots of things are indicators of health or illness: nausea, anxiety, appetite, mood, and so on.
They all affect homeostasis indirectly.
The key distinction is that while pain, nausea, anxiety, et al. affect homestasis, the vital signs are the objective manifestations of homeostasis.