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Despite a decline in the practice of labeling pain as the “fifth vital sign,” patients still are often asked to rate their pain on a 0-to-10–point numerical scale. The implication is that treatment should be focused on reducing the rating to at least the mild range (1 to 3), if not to zero. This goal might not only be impossible to achieve but also could lead to inappropriately raising analgesic dosages and risking misuse or addiction. For this reason, many pain experts focus more on treating to improve function, using functional measures to document progress, and relying more heavily on nonpharmacologic approaches.
Investigators explored this issue in a study of 663 primary care patients (median age, 62) who were receiving analgesics, had a…