Pain As The Fifth Vital Sign

Carefully measuring and recording a loved one’s level of pain can help ensure proper pain management.

By Dr. Amos Bailey

Ouch! You have just stubbed your toe and the pain is excruciating. You can’t do anything. The pain paralyzes you. In a few minutes the pain recedes and you continue on with your life. What if the pain never got better? What if it lasted for days, weeks, or even months? Unfortunately, for many people at the end-of-life, pain is a constant, gnawing problem that can diminish the joy of life. The “SUPPORT Study,” * done in 1995, revealed that according to family members, 50 percent of hospitalized dying people had moderate to severe pain while conscious more than half the time before they died. These startling statistics spurred doctors and caregivers to look for a way not just to treat pain more effectively, but to become more aware of when their patients were in pain, and the level of pain they were experiencing.

The problem is that pain cannot easily be measured. There are also prejudices and fears regarding using pain medication. We know, however, that untreated pain can be a threat to the well-being of people at the end of life especially because it can speed the dying process by literally wearing the person out, preventing them from eating and sleeping regularly. To combat these problems, the Hospice and Palliative Care community came up with a way to incorporate pain measurement into the regular measurement of the four vital signs. Pain would become the fifth

By making pain a priority and incorporating its treatment into regular care, pain assessment and pain medications can become part of normal treatment practice. Pain can almost always be treated effectively with oral medications that can allow people to begin living again. People do not have to be over-sedated or unconscious to have good pain control. When pain is relieved, many people can feel like moving about, eating, and resuming some of their usual activities.

To make pain easier to talk about and to measure, healthcare practitioners have developed a pain scale from zero to five (or one to 10). Often represented by faces, a smiling face at zero is no pain, while a crying face at five is the worst pain possible. The faces between zero and five quantify the severity of the pain. This vital information allows the caregiver and the doctor to know how well medications are working and to quickly adjust the medicine to meet individual needs.

I have seen the transformation of people made mute and immobile by pain, who have rejoined the community of life once their pain is controlled. Anyone can use this simple tool to talk to their doctor about suffering. If your doctor isn't aware of your pain or the pain of loved one who is sick, use the pain scale to tell your doctor or nurse what your fifth vital sign is.

*The SUPPORT study was first published in the November 22, 1995 issue of The Journal of the American Medical Association. The major finding of the $28 million study was that efforts to prolong people’s lives too often merely prolong dying leaving too many people dying alone, in pain, and attached to machines. The entire SUPPORT study, including today’s research, is supported by The Robert Wood Johnson Foundation.

Dr. Amos Bailey is a Hospice and Palliative Care physician who is the medical director of the Balm of Gilead Project in the Jefferson Health System and Cooper Green Hospital, providing end-of-life care to under-served and poor communities in the greater Birmingham, Ala., area. Dr. Bailey was recently recognized as one of 10 national Leaders by the Community Health Leadership Program sponsored by The Robert Wood Johnson Foundation.

Educational Broadcasting Corporation/Public Affairs Television, Inc. Reprinted with permission.

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