The Fifth Vital Sign

In 1999, the U.S. Department of Veterans Affairs (VA) began a new program called “Pain as a Fifth Vital Sign” as a way to draw attention to a symptom that was often ignored. Patients at all medical facilities are generally checked for four main health indicators: pulse, temperature, respiration, and blood pressure. But the VA added pain as another vital sign.

Pain has often not been recognized or treated directly in the American health care system. For example, in a study of 10,000 dying patients published in the Journal of the American Medical Association, researchers found that almost half of these patients died in severe pain. In other studies, researchers found that about three-fourths of patients with terminal illnesses such as cancer are in pain.

Experts say that when doctors assess pain as part of a check-up, this can help patients realize that it is important to talk about their pain. Patients need to know that there are effective treatments for pain and that early treatment can reduce the need for future hospitalizations.  In fact, many studies show that most pain can be relieved and treated.

Some health care providers may not agree with the VA’s model that includes pain as a vital sign. They will argue that they already have so many things to check, such as the patient’s use of alcohol, tobacco, or birth control. But measuring pain can be an easy, quick routine procedure. Patients with no pain do not need any follow-up. Those with significant pain should be treated.

Other health care providers may say that pain “isn’t really a number like blood pressure or heart rate,” or that they “don’t trust a patient’s description of pain.” This can be a problem, but for the patient, pain is very real. The numbers used for pain assessment help the doctor ask the patient about levels of pain more efficiently. Also, the actual numbers are less important than knowing how much the patient’s life is affected by the pain, or how the pain changes from day to day.

In 2000 it became law in California that all health care staff ask about a patient’s pain each time vital signs are checked. This purpose of this law is to ensure that“pain be assessed and treated promptly, effectively, and for as long as pain persists.” The pain assessment should be noted in the patient’s chart, just as other vital signs are measured and recorded. For example, if an institution uses the 0-10 pain assessment scale, a recording of 2/10 fulfills the requirements of the law.

Making pain a vital sign can be a simple step in making pain management a regular part of health care, and another step in improving the patient’s overall quality of life.