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Is the overwhelming problem of too many opioid and narcotic pain prescriptions related to the identification of ‘pain’ as the ‘fifth vital sign’?  Was the intention for the designation, the ‘fifth vital sign’, an expectation that individuals would be pain free during hospital stays, eg, after a surgical procedure, or after visiting ambulatory centers for an injury?

A 12-year-old girl is referred to the office after a routine dilated eye exam shows unusual retinal lesions. The child has been having headaches for the past 2 years that are described as mostly in the vertex with no other associated vomiting symptoms. Headaches are intermittent and usually relieved with ibuprofen.