Patient Safety & Clinical Quality

The Pain Game - How Will Your Hospital Play?

The AMA wants to lose pain as “the 5th vital sign.” How will this affect your hospital?

The Pain Game blog header

Pain: the 5th Vital Sign

The American Medical Association (AMA) wants to lose pain as “the 5th vital sign.”

This resolution was adopted with several other initiatives in 2016 at the annual meeting of the AMA to address opioid overprescribing and allow for better access to opioid addiction treatment. (1) (6)

According to the Pain News Network, “pain as the 5th vital sign” verbiage began in the 1990s which ranked pain as equally important to blood pressure, pulse, respirations, and temperature.

Vital signs are those that can be objectively measured and quantified, however, identifying, treating, and managing pain is central to medical practice, but it is not a readily quantifiable physiologic vital sign according to the AMA and should not be treated as such. (1) (6)


Pain management and The Joint Commission

From a regulatory perspective, currently The Joint Commission (TJC) sees pain management as a patient's right and requires:

  • Healthcare workers to have training on controlling, addressing, and managing pain
  • All practitioners to have education on assessing and managing pain
  • A comprehensive pain assessment consistent with patient condition
  • Use of methods to assess pain that are consistent with the patient's age, condition, and ability to understand
  • Reassessment and response to patient's pain
  • That the hospital either treats the patient's pain or refers the patient for treatment. (TJC says that treatment can be pharmacologic or non-pharmacologic.)
  • Patient education related to pain as approximate for the patient
  • Monitoring of pain after surgical or other procedures or anesthesia or sedation
The Joint Commission standards do not mandate the treatment or assessment of pain as a vital sign but they do require assessment, treatment, and reassessment of patient pain. (10)


TJC Pain Management Infographic

Pain management and HCAHPS

Additionally, management of pain is part of the patient-rated HCAHPS survey.

The questions on which patients rate the hospital include whether or not their pain was well-controlled and if the hospital did all they could to assist the patient with pain.

Patient ratings currently have the potential to impact hospital Medicare reimbursement, but CMS proposed in July that the questions remain on the survey but be removed from the hospital payment scoring calculation. This proposal from CMS also is related to opioid overprescribing. (5)


Pain management and Opioid Addiction

With opioid addiction and related deaths at an all-time high, opioid overprescribing and addiction certainly need addressed, but because pain is the number one symptom patients are seen for, what impact will removing the emphasis on it have for patients? (7)

Chronic pain greatly impacts patient quality of life including restful sleep, ability to think clearly and process information, mood/mental health, cardiac function, and sexual health. Pain can also have a cumulative effect, increase over time, and become a disease itself. (3) (8) (9)


Concerns regarding Removal of Pain as 5th Vital Sign

  • Will physicians' fear of prescribing opioids leave patients with untreated pain? 
  • Will pain be addressed less often?
  • Will patients be less comfortable?
  • Will patients' pain be taken less seriously?
  • How will patients' lives be impacted; will they be able to live and work productively?
  • What about patients with chronic conditions, terminal illnesses, and cancer?


Pain management and your hospital

Is your hospital prepared to manage pain effectively using multi-modal pharmacologic AND non-pharmacologic approaches?

How does your hospital manage acute and chronic pain? Are you prepared with modalities that do not include prescription use of opioids such as hypnosis or dialectical behavior therapy, physical therapy for improvement of function, acupuncture, biofeedback, etc? (4)

When the requirements for assessment change, will your patients’ care suffer?

Interested in previewing Readiness Rounds' Pain Assessment rounding tool? Contact us for a demo.


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