Should Medicine and Public Health Abandon the Opioid Industry's Terminology Surrounding Pain? An Argument for Conceptual Reclamation and Against Guilt-By-Provenance.

Kaspari, Butler, and Fugh-Berman document how opioid manufacturers created or redefined terms such as opiophobia, breakthrough pain, pain as the fifth vital sign, and pseudoaddiction to expand opioid prescribing. Their account is accurate, but industry provenance alone does not resolve whether a term should be abandoned. Opiophobia refers to a genuine underuse of opioids in cancer and palliative care and breakthrough pain names a clinical reality that predates its industry expansion. Pseudoaddiction and pain as the fifth vital sign, by contrast, lack empirical support and function only as promotional constructs. This commentary argues against guilt-by-provenance. Instead, medicine should distinguish terms that capture genuine clinical phenomena from those manufactured to obscure risk, retaining and reanchoring the former rather than surrendering vocabulary industry once exploited. More broadly, given the stakes of diagnostic definitions, the field should begin to openly discuss the tradeoffs of abandoning or reclaiming industry-influenced language.