Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment perspectives on a modern-day medical dilemma

•Prior to the 1980s, chronic pain management was mostly multidisciplinary, and providers used opioids sparingly.•“Pain, The Fifth Vital Sign” campaign contributed to predominance of opioids and interventions in chronic pain management.•Despite wide use of chronic opioid and non-opioid pain management strategies, long-term (>1 year) outcome data is lacking.•Industry and government must fund comparative effectiveness trials that include patients with substance use disorders.

BackgroundOver 100 million Americans are living with chronic pain, and pain is the most common reason that patients seek medical attention. Despite the prevalence of pain, the practice of pain management and the scientific discipline of pain research are relatively new fields compared to the rest of medicine − contributing to a twenty-first century dilemma for health care providers asked to relieve suffering in the “Fifth Vital Sign” era.MethodsThis manuscript provides a narrative review of the basic mechanisms of chronic pain and history of chronic pain management in the United States − including the various regulatory, health system and provider factors that contributed to the decline of multidisciplinary pain treatment in favor of the predominant opioid treatment strategy seen today. Multiple non-opioid pain treatment strategies are then outlined. The manuscript concludes with three key questions to help guide future research at the intersection of pain and addiction.ConclusionsThe assessment and treatment of chronic pain will continue to be one of the most common functions of a health care provider. To move beyond an over reliance on opioid medications, the addiction and pain research communities must unite with chronic pain patients to increase the evidence base supporting non-opioid analgesic strategies.