Since the first century, “Calor, dolor, rubor and tumor,” i.e., heat, pain, redness and swelling, have been recognized as classical signs of a serious health problem, but there has never been a “litmus test” for measuring the severity of pain itself. In the mid-90s a group of clinicians, policy wonks, and patient advocates developed Pain as the Fifth Vital Sign to increase pain assessment and improve pain care. Since its inception, this strategy has been controversial.

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.”

We are pleased to announce the release of An Important View on Pain as a 5th Vital Sign, which is the eighth in a series of briefs profiling policy and educational issues important to improving chronic pain. We wish to thank contriubutors: Jeffrey Fudin, PharmD, DAAPM, FCCP, FASHP, Erica L. Wegrzyn, BS, PharmD, Mena Raouf, PharmD, and Michael Schatman, PhD, and editors: Richard Payne, MD, John B. Francis Chair, Center for Practical Bioethics, Bob Twillman, PhD, FAPM, Executive Director, Academy of Integrative Pain Management and James Cleary, MD, FAChPM, Associate Professor of Medicine University of Wisconsin, Director, Pain and Policy Studies Group.

This policy and educational brief is a product of the Pain Action Alliance to Implement a National Strategy (PAINS) and the Center for Practical Bioethics.

The Policy & Educational Brief Series is designed as a tool for PAINS members to support their work to improve pain policy. In the spirit of the alliance, the Brief is designed as an “open document” so any member organization or individual can brand it with their name and contact information. The back page of the brief is designed with a space marked “This copy is made available to you by:” for easy personalization.

Everyone can download a master electronic copy. Hard copies of the latest issue can be ordered in a package of 10 or 20 for free and there is a flat rate mailing cost of $5.00. If you want larger quantities, please contact us.

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