pain is the fifth vital sign

Some background: I'm working on an account for a morphine formulation that is given epidurally and provides up to something like 24- to 48-hour pain relief depending on dose, which is better than morphine given IV (only 4 hours or so of pain relief per dose). This new drug formulation has been studied in patients who have had hip, back, and caesarian surgeries. The only drawback to it, so far as I can tell, is that, as with any kind of morphine use, overdosing can cause severely decreased respiration, which ironically was exactly the situation my grandmother was in before she died recently. So of course, it's recommended to give the lowest dose possible while still providing pain relief.

As I'm researching the drug and the studies and the whole concept of pain management, I've come across several interesting things, and I'm only thinking about them because I'm weird that way. Vital signs (pulse, blood pressure, core temperature, and respiration) are easily and objectively measured. Pain, however, can't be measured objectively. It's usually assessed as "on a scale of 1 to 10, with 10 being excruciating, rate your pain." People have varied tolerances for pain, so their rating is usually based on previous experience (ie, compared to the most physically painful thing they've ever felt - broken bone, heart attack, giving birth, a severe burn, endometriosis, appendicitis, having teeth pulled, etc.), and the rating changes as people experience physical pain throughout their lives.

Mind you, one can observe a person's response to pain based on vital signs, but to measure pain itself, you really need the patient to describe it to you. And of course, there's the problem of interpretation. The caregiver may be inclined to interpret the pain rating based on their own experience with pain, and they may have to dig a little and ask more questions to clarify the patient's rating. Quite the conundrum.

There is a strong movement now to include pain assessment as part of a standard check of vitals, and though the objectivity mentioned above presents a challenge, I think it will become an important part of health care. Here's why: precisely because of its subjectivity, pain assessment forces caregivers to think of patients as other than objects to be poked, prodded, assessed, and mended on an assembly line. Pain is a human perception that requires dialogue between patient and caregiver for comprehension, evaluation, and treatment, which changes the dynamic of care to one of easing suffering (and by the way, possibly improving vital signs - and no, that's not coincidence), not just fixing what is broken and forgetting that patients, amazingly, are people too. "Whol"istic medicine, here we come!