Emphasis on pain as the fifth vital sign has become the latest fad in medicine receiving undue attention among regulators and health care commentators. Kozol and Voytovich strike at the heart of this issue with a clear description regarding the differences between pain and other physiologic processes. As Kozol and Voytovich point out, pain is not a vital sign despite the popular new jargon; they elegantly describe the vital signs and how they are measured. Early in medical school, we are taught that signs are physiological processes that can be observed and measured. Symptoms are patients' subjective description of their disease state. Pain is a symptom and not a sign. As such, measurement tools will always fall short in precision and accuracy for pain assessment. Promoting pain as a measurable sign leads to misuse of pain measurement tools, overadministration of pain medication, and a rise in complications attributable to pain management.
Livingston EH. Misinterpretation of the Fifth Vital Sign—Invited Critique. Arch Surg. 2007;142(5):419-420. doi:10.1001/archsurg.142.5.419