The ‘fifth vital sign’
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چکیده
Pain is one of the most common symptoms, regardless of the specialty in which a patient is being treated. It should be routinely evaluated and recorded in daily clinical examination. In fact, pain has been promulgated as the ‘fifth vital sign’, in addition to the four traditional vital signs of temperature, pulse, blood pressure, and respiratory rate. As well as improving patient comfort and satisfaction, effective pain management can speed mobilisation after surgery, shorten hospital stay, and reduce costs. However, pain is a subjective perception and, therefore, difficult to quantify. For acute postoperative pain, simple measures such as the visual analogue score, numerical rating scale, or categorical scale have all proven to be of similar accuracy, and most patients can grasp the concept well enough to provide reliable selfreporting. For chronic pain, comprehensive and multidimensional measures such as the Brief Pain Inventory of Wisconsin and the McGill Pain Questionnaire have been developed to reflect the sensory, affective, and functional impairment that is often a consequence of chronic pain conditions. Over the years, a number of more specific pain assessment tools have been developed for neuropathic pain, back pain, etc. To measure the degree of ‘quality of life’ impairment, validated assessment tools are available for specific diseases. Examples include the short-form health survey (SF-36) for non-cancer pain patients, discussed by Lee et al in this issue, and the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires on cancer pain. Such scoring systems are important and reflect the need for a high degree of sensitivity in order to provide adequate response and treatment.
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