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In 1996, during his speech as president of the American Pain Society, James Campbell (5) referred to pain as the fifth vital sign, in order to encourage health personnel to assess patients' pain.
The concept of pain as a purely physical phenomenon reached its zenith in the 1990s, when medical organisations such as the American Pain Society and the Department of Veterans Affairs succeeded in having pain designated a "fifth vital sign," alongside blood pressure, temperature and breathing and heart rate.
Pain is now the "fifth vital sign," and is so common in an aging society that we can no longer afford to mask the pain or just treat symptoms.
About a decade ago, pharmaceutical lobbyists persuaded the Joint Commission, the accrediting agency for most hospitals in the U.S., to list pain management as the fifth vital sign. Patient satisfaction was measured on how well pain was managed, leading to more prescriptions for pain management.
"We made pain the fifth vital sign. It incentivized providers to manage pain to the satisfaction of their patients.
Various specialties have added a fifth sign to suit their needs and focus: an electrocardiogram in cardiology, a cardiotocogram in obstetrics, urinalysis in nephrology, and pain in internal medicine.2 Diabetology uses the glucometer to provide an assessment of glycaemia, which can be termed as the fifth vital sign in diabetes care.
Nurses in the Southern Italy said they were not aware of the existence of a law that requires the measurement of pain as the fifth vital sign, which also affects their familiarity with the instruments used to measure pain.
A lot of us in geriatrics are advocating evaluation of gait speed in all patients as a fifth vital sign. It's probably more useful than blood pressure in some of the older adults coming into our clinics," he said at a conference on internal medicine sponsored by the University of Colorado.
This has led some to suggest that pain assessment should be considered the fifth vital sign. (18,24)
Most gynecologists now widely recognizes a woman's period is her " ( fifth vital sign ," important for both diagnosis and preventative care.
Making pain the "fifth vital sign" and allowing patients to downgrade doctors on surveys if they don't refill narcotic prescriptions compounded the situation.
The beginning of the crisis can be traced back to a 1999 Joint Commission on Health Care initiative that proclaimed "Pain as the fifth Vital Sign." It standardized the use of the now familiar zero to 10 numeric pain scale.