Fifth Vital Sign - American Pain Foundation

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Question & Answer

Fifth Vital Sign

by M. Fishman, MD

Question: What is meant by all of the recent news about pain as the 5th

vital sign?

Answer: Blood pressure, pulse, respiration and temperature have been

defined for many centuries as the basic " vital signs " that indicate good

health. These vital signs are important clues for doctors to diagnose

and treat illness and they also provide doctors with a simple, baseline

compass to determine if a patient is ill. It is now recognized that pain

is also a sign of illness. Pain can provide a useful tool for doctors to

measure and monitor a patient's state of health, illness, and

well-being. Moreover, making sure health care providers check for pain

is usually the first step in recognition and management.

Although pain is subjective, can vary from one patient to another and

from one day to the next, health care providers attempt to measure pain

as objectively as possible. Pain is usually determined by asking the

patient what their pain is like and relating that pain level to a scale.

In adult patients, this scale is often a numeric measurement between 0

and 10, with the number 0 meaning " no pain " and a score of 10

representing " the worst pain imaginable. " Because children may be

unable to grasp the concept of numbers and how they relate to pain, a

pediatric pain scale is utilized for them. This scale is comprised of

expressions on pictured faces. Six faces are normally displayed in front

of the child, with the first face representing a happy expression and

the 6th face describing a grimacing face suffering from intolerable

pain. Both the adult and pediatric pain scales are placed in front of

each patient and they are asked to point or state the level of pain that

best describes what their pain is like.

Patients who are unable to speak, such as an unconscious patient or

someone requiring a breathing machine (respirator), are also carefully

observed for levels of pain. These pain measurements are determined by

closely monitoring the patient's other vital signs (heart rate,

respiration, pulse, and temperature) as well as behaviors such as their

level of agitation, irritation, and restlessness.

Pain scales are useful indicators for doctors to get a sense how much

pain the patient is experiencing. They are also very important measures

that can help determine if treatments are effective or simply not

working to combat pain. Because pain is such an important part of

diagnosis and treatment, the need for doctors, nurses and other health

care providers to register pain as a vital sign is becoming a mandated

part of medical care. These efforts are just one indication of the

heightened awareness of pain as a potentially overlooked source of

suffering. Adding pain as the 5th vital sign may help overcome needless

suffering from pain that is treatable, if we are just aware of it.

January, 2004

http://www.painfoundation.org/page.asp?file=QandA/FifthVitalSign.htm & menu=1

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org