Despite advances in the understanding and treatment of pediatric pain, many hospitalized children continue to experience serious pain, according to a study.

Researchers conducted a survey and medical chart review of 199 patients, ages 7 days to 21 years, treated at Johns Hopkins between 2007 and 2008. They found that 86% of the children experienced pain and 40% experienced moderate or severe pain. Most patients received appropriate and timely therapy, but even with aggressive treatment, some children continued to experience persistent pain.

“While we’ve made tremendous strides, there’s still work to be done,” Lori Kozlowski, RN, MS, CPNP, the study’s lead investigator and a pediatric pain specialist at Johns Hopkins Children’s Center, said in a news release.

Although some of the shortcomings noted in the study reflect the need to better understand pain in children, others point to the need for more effective treatment protocols, the researchers said. The results likely are relevant to other pediatric hospitals, and should be heeded as a call to action by clinicians everywhere, they said.

“Pain is the fifth vital sign which, together with blood pressure, heart rate, breathing and temperature, can provide important clues about a patient’s wellbeing,” said Constance Monitto, MD, the study’s senior investigator and a pediatric anesthesiologist at Hopkins Children’s Center. “Treating a child in pain is a fundamental responsibility of every physician and nurse.”

Specific goals for better pain management identified in the Hopkins study include reducing the overall number of hospitalized children who experience pain, understanding why some children experience disproportionately worse pain and improving pain treatment among those with persistent pain that defies conventional treatment.

In the meantime, clinicians can take some basic steps to ensure timely and appropriate pain therapy, the researchers said. These include taking the time to talk to patients and involving parents in the assessment and treatment of a child by using their insight into the child’s behavior and idiosyncrasies. Another step is factoring in gender, age and individual patient differences.

Other findings:

• Children undergoing surgery experienced pain more often and more intensely than nonsurgical patients.

• A small subset of children — such as children undergoing cancer treatment — continued to experience pain despite aggressive therapy.

• Girls reported higher pain scores than boys, even in same-age patients who underwent the same procedures. The finding suggests hormonal and cultural differences as possible factors.

• Older children, who self-reported their pain, had higher pain scores than infants, toddlers and children with developmental delays. The finding may reflect problems with pain-scoring tools that nurses and physicians use to assess pain in very young and nonverbal children.

• Only a third of the children who were prescribed opioids “as needed” actually received the medication, which suggests a patient’s “need” may not be always properly assessed, verbalized or conveyed to the healthcare team.

• Protocols that allow patients preemptive, around-the-clock access to pain medication should be favored over “as needed” treatment, a cumbersome practice that requires children to contact a nurse or physician and request medication and can result in substantial delays or no treatment at all, the researchers said.

The study is scheduled for publication in Pain Management Nursing. To read the abstract and access the study via subscription or purchase, visit http://bit.ly/M0IceX.