There is no symptom more treated in the history of medicine than pain. As early as 3400 BC, the Sumerian civilization in Mesopotamia cultivated the opium poppy, and 2000 BC writings indicate that doctors crushed opium pods into sap, mixing several concoctions to treat a variety of ailments including pain. Further extraction and purification of opium eventually led to the isolation of morphine to aid in the treatment of pain [1]. In modern medicine, acute or chronic pain is the chief complaint in nearly 80% of outpatient physician visits, representing the primary reason why Americans visit their doctor [2,3]. Furthermore, it is believed that the economic burden of pain in the United States alone is as high as dollar100 billion per year [2]. Of course, the problem of pain is not unique to North America. According to a recent meta-analysis of international studies, the prevalence of chronic pain in adults is greater than 10% [4]. Perhaps for this reason some physicians have called modern health care an epidemic of pain [5,6]. In efforts to improve the treatment of pain, the American Pain Society (APS) began in 1995 to develop guidelines for the assessment and recording of pain [7]. In James Campbell's 1996 APS presidential address, he stated that "If pain were assessed with the same zeal as other vital signs are, it would have a much better chance of being treated properly [8]." Such sentiments led to the "Pain as the Fifth Vital Sign" movement, originally coined by the Veteran's Health Administration in 1999, and paved the way for the establishment of pain measurement standards [9]. Standardized pain scoring systems were fully implemented by the Joint Commission for Accreditation of Health Organizations (now named The Joint Commission) in 2001 [10].
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