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Correspondence |

Pain Assessment Is Vital—Reply

Edward H. Livingston, MD
Arch Surg. 2008;143(1):99a. doi:10.1001/archsurg.2007.25.
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I agree with Dr Rousseau: pain control is a serious issue and education is of paramount importance. Dr Ferrell's response typifies the emotionalism that has driven the movement for pain as a fifth vital sign. Dr Kozol's point was that pain is not a vital sign—it is a symptom—and insisting that it can be accurately measured and, therefore, precisely treated is misleading and dangerous. Dr Ferrell is a research scientist with a PhD, meaning she cannot prescribe narcotic medications. She typifies what those of us in the trenches face: an armchair quarterback. Surgeons stand by a patient's bedside in the middle of the night and face the dilemma of treating a patient's pain and must balance that treatment against the potential complications posed by analgesic medications. The next morning, we are subject to intense criticism by those who never engage in this sort of decision making. In the worst of circumstances, a physician has to defend his actions in court and, as pointed out in my commentary, potentially lose great deals of money because of unrealistic expectations by the lay public regarding what we can medically accomplish in terms of pain control.

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