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Robert Kozol, MD, MSA; Anthony Voytovich, MD

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In reply

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 . . . [Full Text of this Article]

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Misinterpretation of the Fifth Vital Sign
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