**DISCLAIMER FOR POTENTIAL FUTURE EMPLOYERS: This article relates a personal view, along with references from published articles. It does not and should not be implied that I will not follow your facility's protocol.** (With that being said....)
Is pain really a vital sign? Should it be considered a vital sign?
Well, what is a "vital sign"? Vital comes from the Latin word Vita, meaning life, so signs of life, more so the pulse rate, respiratory rate, body temperature, blood pressure, and often pulse oximetry, important body functions that are measured to see if someone is alive or stable. When a vital sign is abnormal it has the potential to be fatal. So, can your patient die from a 10/10 pain? No.
"This pain is KILLING me nurses! Do something!"
Although the pain can be excruciating, the pain itself will not kill someone, whatever is causing the pain might. Now, pain still needs to be treated, because we want our patients to be comfortable and not suffering. But pain management needs to be realistic, we want to control it, we won't always make it go away.
I do assess pain as part of diagnosis and symptoms to assess the effectiveness of the treatment. The concern I hold for the push for pain management awareness is the HCAHPS and Press-Ganey surveys. In the surveys the patients are asked what their perception was of how well they feel their pain was managed. (Yes, their perception. Pain is subjective, unlike other vital signs that are objective measures). If pain is a vital sign, why aren't the other 5 included in the HCAHPS survey? How well was your blood pressure managed? How well was your heart rate controlled?
Some may say that embodying the patient's pain along with vital signs may cause the health care providers to over treat pain, thus increasing the national opioid epidemic. The President of the American Medical Association, Andrew Gurman, MD, said in a statement that physicians played a key role in the opioid epidemic by overtreating and overprescribing pain medications, and they now have to do their part to help end it. As a result, the AMA decided to drop pain as a vital sign.
Some healthcare professionals criticize the Joint Commission for setting the pain management standards too high, making the patients expect zero pain always. "Judging health care facilities on an overly subjective measure – that is, how well it is perceived that they treat pain is an overly simplistic approach to measuring clinical effectiveness," said AMA Board chair Patrice Harris, MD, in a statement to Pain News Network “Insurers must cover non-opioid and non-pharmacologic therapies that have proved effective. Insurers must take a broader view to give patients and physicians more choices," said Harris, “These policies will save lives. That's the bottom line.”
We continue to assess and treat pain. But we must remember that pain is a symptom, and while managing pain, we have to find and treat the underlying conditions. We need to continue providing frequent patient education and trying non-pharmacological therapies first. But then again, are patients really looking for non-pharmacological therapies while in the hospital?
It will be interesting to see the shift back, if any, from the push by hospitals that have instructed us nurses, and hit on the issues time after time, to get more and more medications to help pain if not relieved by others. Now that we have recognized there is an issue, and we as healthcare providers are part of the problem, I wonder if hospitals will fight back and help the patients, or continue to hammer on patient satisfaction?
Now, there are conditions that opioid medications are necessary for a patient to function and carry on their daily activities, and I'm am not trying to minimize your pain. We all have to agree that their is an abuse of system happening in the country, and actions need to be taken.
The Dude Nurse
Klaus Campos, BSN-RN