In Part I and Part II of this series we’ve introduced the idea that contemporary pain management strategies have resulted 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. The run-up to the current epidemic appears to have its roots in including pain as the “5th Vital Sign” in national pain management strategies. But, have contemporary pain management strategies (including pain as the 5th Vital Sign) been effective?
A 2006 study by Mularski et al. found that routinely measuring pain by the 5th Vital Sign failed to increase the overall quality of patient pain management. A study authored by Karl Lorentz and his colleagues challenged the accuracy of pain as the 5th Vital Sign when used within an outpatient setting. Another 2009 analysis conducted by Franck and Bruce found that in spite of efforts to increase the use of pain management strategies among practitioners, compliance with the use of standardized pain assessment tools in clinical practice has been poor. And, a group of researchers has questioned the effectiveness of long-term opioid therapy for treating chronic non-cancer pain.
Collectively, these examples point to the idea the effectiveness of current strategies to manage pain are short of optimal…in other words including pain as the 5th Vital Sign may be causing more harm than good. Some believe that introducing pain as a vital sign effectively monetized pain to the point where treating pain pharmaceutically, regardless of practitioners possessing the capacity to do so safely, turned pain management into a profit center rather than a cup of relief to aid suffering.
Given the less than optimistic view of the effectiveness of pain management strategies as reflected in the examples above you might think there isn’t much that can be done to reverse the downward spiral of prescription drug misuse and abuse that is plaguing our nation. We’re trying. Next week I’ll cover current efforts championed by public health that may hold the key to reversing the tide.