IN my business or profession I see all kinds. One thing we are seeing more of lately is people being admitted with pain, but all the tests show no reason for the pain. Then a clue lights up as you try to withdraw the medication they get more demanding and then abusive. You might say that is normal for someone in pain. No it is not. When you see these people, without them knowing it they are not showing any behavior of pain. They can be bright people and will not let you do some tests that you need, because it will show nothing. Several years ago the medical establishment started using pain scales, 1-10 or what ever number you like with faces associated with each level of pain, and they tried to say that this is the 5th vital sign. Vital signs, as the term sign means in medicine, is an objective measurement of a vital function. You have number for a temperature, a number for the respiratory rate, heart rate and blood pressure. These are objective measurments, you can measure. Pain cannot be measured, it is subjective. Also, when someone is in pain there are usually secondary behaviors you can describe. Also, in our society and medicine today we want people to be happy or make them feel better, a laudable objective. However, I also remember many years ago I saw three people who had ligit medical problems and required narcotics. I gave it to them, however, they start wanting more and more. I then suggested that they need to come off the narcs and they agreed. I never saw them again as patients, but 2 weeks later our local pharmacy was broke into by professionals and they went straight for the schedule II narc safe and opened it. Six months later the Kansas BI arrested them for selling the narcs they were getting from me and other doctors on the street in Kansas City. This is just one example, I have more if need be. The point is the so called 5th vital sign is a joke. Also, we would like for our patients to be happy and without pain. However, people of lesser quality know this and like good criminals, anitsocials or whatever label you want to apply use the quality in us of helping people for their own ends. It is not uncommon in Emergency rooms for the person to get shots of very powerful narcotics almost as they walk in the door. A lot of times they are admitted for pain control. When they are discharged they come back later getting more and more pain meds. Is this really right or good for them. Yes it makes them happy. If want to do things to make one happy, how about a serial killer. Killing people makes him happy, so shall we provide people for him to kill. How about alcoholics, booze makes them happy, but they die from liver failure, bleeding from the mouth and anus. With all the costs that entails. So what makes people happy and what is right are two separate things. As physicians we need to concentrate on what is right, even if it doesn't make the patient happy, because that is the right thing to do and will benefit the patients health. But, we are not prisons and not a dictatorship and there is no law in this country against being stupid, for the patient or the physician.