By Anthony Romeo
There is an epidemic of opioid use and prescriptions in the United States directly related to physicians’ desire to care for patients with pain. The United States consumes 80% of the worldwide legal opioid supply, despite only being 4.5% of the world’s population.
If one event may be considered a catalyst of the opioid epidemic, it was the designation of pain as the fifth vital sign. In the late 1990s, the American Pain Society promoted pain as the fifth vital sign to be included in every routine assessment by health care providers. It has been one of the most successful marketing programs in medicine, leading to the rapid expansion of pain management. 
In 2000, the movement toward better care of pain led to the development of guidelines for pain assessment in Pain as the 5th Vital Sign Toolkit, which later became a Joint Commission standard. That year, President Clinton signed H. R. 3244 which declared 2000 to 2010 as the Decade of Pain Control and Research.
Anthony A. Romeo
Pain is not a sign by any definition. Unlike the original four vital signs, pain is not objectively measured and imparts a patient’s bias and life experience into the assessment. There can be a disconnection from pain symptoms and how they relate to medical or surgical conditions. Pain should not be considered a sign whose presence objectively indicates a specific medical or surgical condition.
Incentives
Other factors have continued to foster a strong emphasis on pain management. Incentives are driven by the false belief that patient care should be free of pain. There is an increasing focus on a patient-centric system that assesses the value of care by patients’ experiences. Topping the list of the patient experience and perceived satisfaction is their evaluation of how health care providers managed their pain. Patient responses directly affect the most influential driving force in health care, which is not the various experts’ opinions on what constitutes value, but rather financial reimbursement. CMS has weighted patient satisfaction at 30% of the purchasing program. Hospitals and other health care systems have implemented patient satisfaction surveys and tools to not only demonstrate value to the patient, but also to provide feedback to physicians and other health care providers on their ability to satisfy patients. The patient’s pain experience plays a vital role in this process.