The Fifth Vital

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How may clinicians have responded to the information they see at every patient encounter regarding the presence of pain? Having the knowledge that their patients are in pain, would often prompt clinicians to react with a response to treat the pain. This has led to an increase in opioid medication prescribing when acetaminophen and NSAIDS fail. Dispensing opioids has almost doubled according to National Health and Nutrition Examination Survey data showing that from 1988–1994, 3.2 percent of Americans reported using opioids for pain while from 2005–2008, 5.7 percent reported use. 3 This significant increase has been associated with serious consequences including an estimated 40 deaths per day due to prescription opioids. 4– 5 Many patients are reluctant to report pain. When they do, they may underreport its severity. Patients may not share their existence of pain because they want to be “good” patients or do not want to bother or distract their caregivers from other issues in their care. In patients with a history of cancer, pain can be an unwanted reminder of the disease and its progression.

Precipitating factors. Does the person associate any activities, food, or other environmental factors with the onset of pain? What does the patient think causes the present pain? Was the onset of pain sudden or slow? Has the patient done anything or taken anything to relieve the pain? What were the results of the intervention? Lohman D, Schleifer R, Amon JJ. Access to pain treatment as a human right. BMC Med. 2010; 8:8. doi: 10.1186/1741-7015-8-8 I stumbled across a Logan Paul video, and watched my first ever Logan Paul VLOG. A guy who’s constantly hounded by the press and can’t go a step wrong without making another headline. But at the same time someone who genuinely seems like a down to earth guy who’s using his fame to provide a better life for those around him and bring them on his journey with them. Explain the importance of collaborating with the health care team in developing the pain management plan of care. People with acute pain may have physiologic changes, such as tachycardia and blood pressure changes. Blood pressure is usually increased initially and then decreased. However, not all patients with acute pain have these signs, so his or her statement of pain is the only reliable indicator.Chauhan C. The perception of perception. J Clin Oncol. 2007;1; 25( 16):2329–30. doi: 10.1200/JCO.2007.03.001 how best to manage critical aspects of your health, including better sleep, exercise and a healthier diet;

Character and quality of pain. What words does the patient use to describe the pain and its character, quality, or intensity? It’s well worth a read. Knowing that no matter your upbringing or your situation you and you alone can change that. Your mentality and perseverance is put to the test to see you grow as a person and to further your ambitions. As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, Everyone experiences pain at some point in life. Because pain is such a private and personal experience, it may be difficult to describe or explain to others. The amount of pain and responses to it vary from person to person; therefore interpreting pain solely on actions or behaviors can be misleading. Historically, the former president of the American Pain Society, James Campbell, introduced the idea of “Pain as the 5 th Vital Sign” (P5VS) in 1996. According to this concept, pain intensity should be regularly assessed, together with the classic four vital signs. However, unlike the classic four vital signs, self-reporting of pain is a subjective measurement, and clinicians should accept patient reports and act upon them. Three years later, the P5VS campaign credibility increased substantially after being adopted by the Veteran’s Health Administration. In the same year of 1999, Assembly Bill 791 (Thomson) was signed in California to implement the assessment and prompt treatment of pain, it is recorded in the patient’s chart in a manner consistent with other vital signs [ 2, 11– 13]. Likewise, the standards of pain assessment, follow-up, and uniform measurement were introduced as patients’ rights by the Joint Commission on Accreditation of Healthcare Organization (JCAHO) in 2000. This fact was followed by the North American pain management guidelines updates, including recommendations for pain assessment and documentation [ 3, 7, 14].

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Robert Englund’s book Hollywood Monster, a number of Corey Taylor books, Slash’s autobiography and The Motley Crue book The Dirt have been the only books in existence to ever grab my attention. Al Samaraee A, Rhind G, Saleh U, Bhattacharya V. Factors contributing to poor post-operative abdominal pain management in adult patients: a review. Surgeon. 2010; 8( 3):151–8. S1479-666X(09)00040-7 [pii] doi: 10.1016/j.surge.2009.10.039 Takes a severe plummet in quality around the final third / quarter. The part documenting the post-rehab years. Not exactly because of that but I understand it’s harder to make stories of anxiety in recovery as interesting as guns and class A’s. But the narrative tried too hard to counter that, resulting in cliche and melodrama. I’m sure I don’t need to explain why ending a chapter: “ I had no idea what was in store...” (yes including the ellipsis) makes me less interested to find out, not more. The prose towards the beginning , while not exactly sophisticated , could have an intelligent flourish, so it feels like the whole thing ran out of steam.