Letter to the Editor  |   April 2017
Fifth Vital sign, 15 years later
Author Affiliations
  • H. F. Nicodemus, M.D.
    Rockville, Maryland
Article Information
Letter to the Editor
Letter to the Editor   |   April 2017
Fifth Vital sign, 15 years later
ASA Monitor 04 2017, Vol.81, 72-73.
ASA Monitor 04 2017, Vol.81, 72-73.
Recent media accounts showed opiate-related deaths exceeded that from gun-related homicides.In addition, the media noted that for the first time since 1993, there is a decline in the average life expectancy, in part due to opiate-related deaths among young users. Rightly so, ASA is deeply involved in activities to reduce addiction that resulted from over-prescription and use of opiates for pain control.
In the February 2001 issue of theASA NEWSLETTER, my letter to the editor expressed concern that lawsuits mayincrease with The Joint Commission mandate to include pain assessment score as the fifth vital sign.1 Each patient-physician encounter required a record of pain score, which if inadequately treated provides documentation that may be used in a lawsuit. One result is that medical practitioners treating pain overreacted and over-prescribed opiates, leading to addiction in many users. Patients suffering from painful conditions soon learned that faked high pain scores encouraged physicians to give higher unit doses and also greater number of doses in each prescription. Thus, not only did patients have more drugs to take themselves, it also allowed them to divert some for any personal gain. Further, pain score is now used as a universal scale for pain intensity. Using the pain score in this manner is irreproducible and it lacks conventionally agreed modifiers to denote the character of pain.
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