Pain is the Fifth Vital Sign [...]

“Pain is the Fifth Vital Sign” was a campaign which changed doctor’s views about prescribing opioid medications. It is largely seen to have been a mistake, and many have claimed that it was funded and pushed by the maker of OxyContin.

Between 1996 and 2002, Purdue Pharma funded more than 20,000 pain-related educational programs through direct sponsorship or financial grants and launched a multifaceted campaign to encourage long-term use of OPRs for chronic non-cancer pain (86). As part of this campaign, Purdue provided financial support to the American Pain Society, the American Academy of Pain
Medicine, the Federation of State Medical Boards, the Joint Commission, pain patient groups, and other organizations (27). In turn, these groups all advocated for more aggressive identification and treatment of pain, especially use of OPRs.

For example, in 1995, the president of the American Pain Society introduced a campaign entitled “Pain is the Fifth Vital Sign” at the society’s annual meeting. This campaign encouraged health care professionals to assess pain with the “same zeal” as they do with vital signs and urged more aggressive use of opioids for chronic non-cancer pain (9). Shortly thereafter, the Veterans’ Affairs health system, as well as the Joint Commission, which accredits hospitals and other health care organizations, embraced the Pain is the Fifth Vital Sign campaign to increase the identification and treatment of pain, especially with OPRs. Similarly, the American Pain Society and the American Academy of Pain Medicine issued a consensus statement endorsing opioid use for chronic non-cancer pain (31). Although the statement cautioned against imprudent prescribing, this warning may have been overshadowed by assertions that the risk of addiction and tolerance was low, risk of opioid-induced respiratory depression was short-lived, and concerns about drug diversion and abuse should not constrain prescribing.


The JCAHO would later give an even more direct push to opioid prescription with its report Improving the Quality of Pain Management Through Measurement and Action

Some studies in the 1980s and 1990s had argued for more liberal use of OPRs. See Perils of a Small Study, Opioid Edition

Between 1995 and 2000, as this campaign was being pushed to doctors, Purdue Pharma saw A 2,000 Percent Increase in sales, mostly in OxyContin.

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