We were surprised to see that our article describing potential misinterpretation of subjective reporting of pain scores was seen as a blanket condemnation of “the fifth vital sign.” The common goal is to move toward thoughtful assessment of suffering in our patients and to relieve pain while avoiding dangerous adverse effects of therapy. In the early days of anesthesia, had one pointed out that ether was toxic, explosive, and hard to control, it might similarly have been seen as “setting the field back 20 years.” Indeed, in both cases, critical analysis of ongoing practice is an essential first step toward refining future efforts. Our aim was to review contemporary literature, both clinical and basic science, and to understand the bases for potential error in the application of pain scores. We recognize the role of pain scales in directing treatment and we encourage investigators to strive for better means of measuring patient's pain levels. We agree with Dr Rousseau that greater education among care providers is a necessity. We also concur that one should evaluate the patient and not simply rely on the pain scale when ordering narcotics. There is more work to be done!
Kozol R, Voytovich A. Pain Assessment Is Vital—Reply. Arch Surg. 2008;143(1):99. doi:10.1001/archsurg.143.1.99