I don’t often get to say “Hooray for the AMA!” but its recommendation to eliminate the practice of considering pain as a fifth vital sign has my enthusiastic support. For years I have been annoyed when my own vital signs are being taken in preparation for a routine physical exam and the medical staff, aided by pain scale emoticons, dutifully asks me about my pain level. I felt unwillingly drawn into a scam supporters of pain pill industry instigated, and institutions, such as the Joint Commission and the Veterans Health Administration, promulgated.
Opportunistically exploiting the fact that pain was being under-treated by physicians, pharmaceutical companies – most infamously Purdue-Pharma – launched a highly effective campaign in the late 1990s to increase sales of their product, fueling the opioid epidemic that has addicted and killed so many people. One of their more ingenious ideas was to pressure clinicians to ask patients about pain even if they did not complain about it. Pain, which is a symptom, was mislabeled as a “sign” and added to the traditional vital sign routine that has been a standard first step of physical examinations.
The Joint Commission, which accredits hospitals, was then convinced to add this metric to their determination of the quality of care being delivered. The AMA has also expressed a desire to work with the Joint Commission to find alternate ways to monitor the proper management of pain. To their credit, the Veterans Health Administration has already stopped using this language. Another AMA recommendation was for insurance companies to expand their coverage of pain management treatments that used alternative approaches to opioid medication.
I am heartened to see changes such as this, especially from the AMA, which had earlier lobbied against proposals before the FDA requiring a demonstration of basic knowledge about opioids and pain management before a physician would be allowed to prescribe opioid medication. Some physicians in the pain treatment community oppose these changes as being too extreme. While I believe that it is important that the pain treatment “pendulum” not be allowed to swing to an extreme in the other direction, these changes do not appear to me to present that danger.
Significant problems remain in continuing to change prescribing practices and helping chronically over-medicated patients reduce their dependence on opioids. Physicians as a group are well positioned to recommend a reasonable balance. Having been part of the problem of overprescribing of opioids, physicians – now better informed — are taking a leadership role in constructively addressing the problem.