Scrap Pain as 5th Vital Sign?
Written by Editor   
Thursday, May 12, 2016 12:00 AM

In 2001, the Joint Commission rolled out its Pain Management Standards, which helped grow the idea of pain as a "fifth vital sign." It required healthcare providers to ask every patient about their pain, given the perception at the time was that pain was undertreated.  Since that time, the U.S. has experienced a surge in opioid prescriptions — and, subsequently, an increase in overdoses and deaths tied to these painkillers.

Advocates are urging the Joint Commission and CMS to scrap policies that they say can lead to opioid overprescribing.  In separate letters to both groups, Physicians for Responsible Opioid Prescribing (PROP)  asked the Joint Commission to re-examine its Pain Management Standards — which once helped push the idea of pain as the “fifth vital sign" -- and asked CMS to strike patient satisfaction questions about pain from its reimbursement procedures.

"Pain is a symptom, not a vital sign," the letter states, noting that vital signs such as blood pressure, heart rate, respiratory rate, and temperature can be measured objectively.

Linking reimbursements to patient satisfaction with pain treatment results in opioid overprescribing, the groups said.

"Aggressive management of pain should not be equated with quality healthcare as it can result in unhelpful and unsafe treatment, the endpoint of which is often the inappropriate provision of opioids," they wrote.

In a statement, Joint Commission vice president David Baker, MD, MPH, said: “the Joint Commission’s standards require that patients be assessed for pain, and if they are experiencing pain, then it should be managed.”  

The letters parallel Congressional efforts to strike the pain management patient satisfaction questions from CMS reimbursements, which are included in the bipartisan Promoting Responsible Opioid Prescribing (PROP) Act in the Senate.