"The cure is worse than the disease", it has been
said about some supposed remedies. We
might be at that point in the treatment of acute and especially chronic pain
with opioid (narcotic) analgesics. In
this article in the May 9th issue of JAMA Dowell et al make the astute observation that as opioid
related deaths have quadrupled in the last decade or so, people have not become
more susceptible to the drugs - it's just that their exposure has
increased. Exposure increased because
several alleged patient advocacy groups (American Pain Society, Veteran's
Health Administration, the Joint Commission) campaigned to convince physicians
that they were not adequately recognizing and treating pain, callously leaving
countless patients unnecessarily writhing in abject misery. Led by these and other coalitions of
busybodies, we went from possible undertreatment of pain (with narcotics) straight
to guaranteed bona fide undeniable overtreatment (with a brief pass through [but
not a stop at] optimal treatment). Part
of this overzealous campaign was the coining (original source unknown) of the
contagious catchphrase "pain as the fifth vital sign."
This is interesting because pain is a SYMPTOM, something
reported by a patient (part of the HISTORY), whereas a [vital] SIGN is an
observation or measurement (part of the PHYSICAL EXAMINATION) made by a
practitioner such as blood pressure, heart rate, a bruise on the skin, a
pulsatile uvula (Muller's sign), or some other finding. (The more rare, uncontemporaneous, and
useless a sign is, the more likely its name is an eponym.) But the pain coalition (PC) successfully
circumvented this convention by cooking up pain scales and cutesy numbered
diagrams bounded by smiley faces and sad faces, adding a cloak of objective
legitimacy to the subjective experience of pain.
