In our lifetimes, each one of us is likely to experience pain. The pain experience could be acute and resolve itself in short order (like a bee sting). Pain can also be a chronic experience lasting a long time with varying levels of intensity (like rheumatoid arthritis). Pain is also subjective and what one person considers excruciating pain, another person may barely notice.
Today, more than any other time in history, we know more about the physiological and pathological dimensions of pain. However, we’re struggling with pain management at the population health level. The US healthcare system has become much more aggressive in the treatment of pain over the last 15 years…resulting in an epidemic of painkiller misuse and abuse that’s killing large numbers of people. In fact, misuse and abuse of opiate prescription painkillers takes out more people every year than car crashes. How did we get here?
The origins of the story could be traced to November 11, 1996. During his presidential address to the American Pain Society, James Campbell, MD introduced the phrase, “Pain as the 5th Vital Sign”. In his speech, Dr. Campbell emphasized the importance of including pain as part of the four traditional vital signs: body temperature, blood pressure, heart rate, and respiratory rate…saying that “Vital Signs are taken seriously. If pain were assessed with the same zeal as other vital signs are, it would have a much better chance of being treated properly. We need to train doctors and nurses to treat pain as a vital sign. Quality care means that pain is measured and treated.”
Shortly thereafter, two prominent stakeholders in the delivery of healthcare services embraced pain and pain management as a cornerstone of the care spectrum. In 1999, the Veteran’s Health Administration included pain as the 5th Vital Sign in their national pain management strategy. Two years later, the Joint Commission on Accreditation of Healthcare Organizations released Standards Related to the Assessment of Treatment of Pain.
The institutionalization of pain by these respected entities was motivated by their interest in delivering comprehensive and appropriate pain care – but doing so also sparked a wildfire of unintended consequences that continues to ravage our healthcare landscape to this day. Part 2 of 5 next week.