Is pain still the "5th Vital Sign"?

2 I believe that when we went to using pain as "the 5^th 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?
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.

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.

I thought pain was the "6th vital sign" but either way, I do ask.

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.

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.

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.

Quote from hiddencatRNI'm still surprised how many patients won't mention anything about pain or discomfort until asked directly if they have any.

Quote from OneLoveNurseI 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?

Quote from AltraI 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.

Quote from Aurora77As 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.

Quote from SuzieFOops, 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.

I agree with the OP. While patients should be assessed for pain, the "asking" so frequently about pain, is one of the questions on the survey the patient will receive in the mail... soon these things will be part of reimbursement contingency. Administration is not concerned for the patient's well-being here so much - it's about survey scores and and filling out things involved with Meaningful Use tabs on the EMR.... revenue generators.