For two decades, much has been made of Pain as the 5th Vital Sign, a policy strategy to improve pain care initiated in the mid-1990s. “Calor, dolor, rubor and tumor,” i.e., heat, pain, redness and swelling, however, have been recognized as classical signs of a serious health problem since the 1st century. Acceptance of Pain as the 5th Vital Sign by the American Pain Society, the Department of Veterans Affairs, The Joint Commission (TJC) and others resulted in a flurry of optimistic dialogue among advocates for improved pain care. The recent brouhaha about Pain as the 5th Vital Sign presents a negative image of this earlier discourse and stems from efforts by those who believe that it has caused or significantly contributed to the current opioid “epidemic.”

In attributing the acceptance of Pain as the 5th Vital Sign as a primary cause of the American opioid crisis, advocates in pain and addiction medicine intent upon dramatically reducing the use of opioids for pain care created a straw man upon which they have relied to further an agenda-based rather than an evidence-based policy platform. Authors of this article believe that for those who strive for a sagacious, moderate, and pro-patient approach to opioid therapeutics and safety must illuminate the current situation and thereby, hopefully, allow and encourage health care providers to continue to assess patients’ pain AS IF it was a vital sign.