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Paul Rousseau, MD

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I read with interest the commentaries on pain as the fifth vital sign by Drs Kozol, Voytovich, and Livingston in the May issue of the Archives.^1-2 Although their subjective comments regarding the adverse consequences of pain as a fifth vital sign are bolstered by referenced studies, they fail to address one of the primary reasons for unfavorable outcomes in the arena of pain management: a lack of education among physicians regarding pain management principles and analgesic pharmacology. Dr Livingston makes the point best when he describes the litigation of an 85-year-old elderly gentleman with pulmonary compromise who suffered a respiratory arrest in the emergency department after receiving morphine (I wonder what dose of morphine he received and whether he was opioid naive) but was then admitted and variously prescribed a fentanyl citrate patch, meperidine, and acetaminophen/hydrocodone. Although the chronological use of these medications is not indicated, . . . [Full Text of this Article]

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Misinterpretation of the Fifth Vital Sign
Robert A. Kozol and Anthony Voytovich
Arch Surg. 2007;142(5):417-419.
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