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.

The role of pharmaceutical companies in promoting overuse of opioids by influencing medical discourse is underexamined. Marketing messages have been seeded in journal articles, continuing medical education (CME), prescribing guidelines, educational activities, and professional society recommendations. Terms generated or redefined by industry created a framework for promoting opioids. This paper focuses on the terms “opiophobia,” “pseudoaddiction,” “breakthrough pain” and “pain is the 5th vital sign.” The reframing of incipient opioid use disorder as “tolerance” and “dependence” is also discussed. The proliferation of these industry-supported terms within medical discourse created a false evidence base that opioids were safe and effective for chronic pain and that withholding opioids deprived patients of the best care.