Original Article| Volume 15, ISSUE 1, P22-35, March 2014

Pain Prevalence, Intensity, Assessment and Management in a Hospitalized Pediatric Population


      New research, regulatory guidelines, and practice initiatives have improved pain management in infants, children, and adolescents, but obstacles remain. The aim of this study was to identify the prevalence and demographics of pain, as well as pain management practice patterns in hospitalized children in a tertiary-care university hospital. We prospectively collected data including patient demographics, presence/absence and location of pain, pain intensity, pain assessment documentation, analgesic use, side effects of analgesic therapy, and patient/family satisfaction. Two hundred male (58%) and female, medical and surgical (61%) patients, averaging 9 ± 6.2 years were studied. Pain was common (86%) and often moderate to severe (40%). Surgical patients reported pain more frequently when enrolled than did medical patients (99% vs. 65%). Female gender, age ≥5 years, and Caucasian race were all associated with higher mean pain scores. Furthermore, females and Caucasian children consumed more opioids than males and non-Caucasians. Identified obstacles to optimal analgesic management include lack of documented physician pain assessment (<5%), a high prevalence of “as needed” analgesic dosing, frequent opioid-induced side effects (44% nausea and vomiting, 27% pruritus), and patient/family dissatisfaction with pain management (2%-7%). The data demonstrated that despite a concentrated focus on improving pain management over the past decade, pain remains common in hospitalized children. Identification of patient populations and characteristics that predispose to increased pain (e.g., female, Caucasian, postoperative patient) as well as obstacles to analgesic management provide a focus for the development of targeted interventions and research to further improve care.
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        • Ahlers S.J.G.M.
        • van Gulik L.
        • van der Veen A.M.
        • van Dongen H.P.A.
        • Bruins P.
        • Belitser S.V.
        • de Boer A.
        • Tibboel D.
        • Knibbe C.A.J.
        Comparison of different pain scoring systems in critically ill patients in a general ICU.
        Critical Care. 2008; 12: R15-R22
      1. American Pain Society (2000). Decade of pain control and research. Retrieved October 13, 2010, from

        • Barsky A.J.
        • Peekna H.M.
        • Borus J.F.
        Somatic symptom reporting in women and men.
        Journal of General Internal Medicine. 2001; 16: 266-275
        • Cepeda M.S.
        • Carr D.B.
        Women experience more pain and require more morphine than men to achieve a similar degree of analgesia.
        Anesthesia and Analgesia. 2003; 97: 1464-1468
        • Chisholm C.D.
        • Weaver C.S.
        • Whenmouth L.F.
        • Giles B.
        • Brizendine E.J.
        A comparison of observed versus documented physician assessment and treatment of pain: The physician record does not reflect the reality.
        Annals of Emergency Medicine. 2008; 52: 383-389
        • Cicero T.J.
        • Nock B.
        • Meyer E.R.
        Sex-related differences in morphine’s antinociceptive activity: Relationship to serum and brain morphine concentrations.
        The Journal of Pharmacology and Experimental Therapeutics. 1997; 282: 939-944
        • Cohen L.L.
        • Lemanek K.
        • Blount R.L.
        • Dahlquist L.M.
        • Lim C.S.
        • Palermo T.M.
        • McKenna K.D.
        • Weiss K.E.
        Evidence-based assessment of pediatric pain.
        Journal of Pediatric Psychology. 2008; 33: 939-955
      2. Dahl, J.L., & Gordon, D. G. (2002). Joint Commission pain standards: A progress report. APS Bulletin, 12(6). Retrieved October 13, 2010, from

        • Ellis J.A.
        • O’Connor B.V.
        • Cappelli M.
        • Goodman J.T.
        • Blouin R.
        • Reid C.W.
        Pain in hospitalized pediatric patients: How are we doing?.
        The Clinical Journal of Pain. 2002; 18: 262-269
        • Fortier M.A.
        • MacLaren J.E.
        • Martin S.R.
        • Perret-Karimi D.
        • Kain Z.N.
        Pediatric pain after ambulatory surgery: Where’s the medication?.
        Pediatrics. 2009; 124: e588-e595
        • Gordon D.B.
        • Pellino T.A.
        • Miaskowski C.
        • McNeill J.A.
        • Paice J.A.
        • Laferriere D.
        • Bookbinder M.
        A 10-year review of quality improvement monitoring in pain management: Recommendations for standardized outcome measures.
        Pain Management Nursing. 2002; 3: 116-130
        • Gottschalk A.
        • Berkow L.C.
        • Stevens R.D.
        • Mirski M.
        • Thompson R.E.
        • White E.D.
        • Weingart J.D.
        • Long D.M.
        • Yaster M.
        Prospective evaluation of pain and analgesic use following major elective intracranial surgery.
        Journal of Neurosurgery. 2007; 106: 210-216
        • Green C.R.
        • Anderson K.O.
        • Baker T.A.
        • Campbell L.C.
        • Decker S.
        • Fillingim R.B.
        • Kalauokalani D.A.
        • Lasch K.E.
        • Myers C.
        • Tait R.C.
        • Todd K.H.
        • Vallerand A.H.
        The unequal burden of pain: Confronting racial and ethnic disparities in pain.
        Pain Medicine. 2003; 4: 277-294
        • Griffin R.A.
        • Polit D.F.
        • Byrne M.W.
        Stereotyping and nurses’ recommendations for treating pain in hospitalized children.
        Research in Nursing and Health. 2007; 30: 655-666
        • Groenewald C.B.
        • Rabbitts J.A.
        • Schroeder D.R.
        • Harrison T.E.
        Prevalence of moderate-severe pain in hospitalized children.
        Pediatric Anesthesia. 2012;
        • Guinsburg R.
        • de Araujo Peres C.
        • Branco de Almeida M.F.
        • de Cassia Xavier Balda R.
        • Cassia Berenguel R.
        • Tonelotto J.
        • Kopelman B.I.
        Differences in pain expression between male and female newborn infants.
        Pain. 2000; 85: 127-133
        • Hannallah R.S.
        • Broadman L.M.
        • Belman A.B.
        • Abramowitz M.D.
        • Epstein B.S.
        Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery.
        Anesthesiology. 1987; 66: 832-834
        • Hong J.Y.
        • Han S.W.
        • Kim W.O.
        • Kil H.K.
        Fentanyl sparing effects of combined ketorolac and acetaminophen for outpatient inguinal hernia repair in children.
        The Journal of Urology. 2010; 183: 1551-1555
        • Krane E.J.
        • Yaster M.
        Transition to less invasive therapy.
        in: Yaster M. Krane E.J. Kaplan R.F. Cote C.J. Lappe D.G. Pediatric pain management and sedation handbook. Mosby, St. Louis1997: 147-162
        • Mather L.
        • Mackie J.
        The incidence of postoperative pain in children.
        Pain. 1983; 15: 271-282
        • Maxwell L.G.
        • Kaufmann S.C.
        • Bitzer S.
        • Jackson Jr., E.V.
        • McGready J.
        • Kost-Byerly S.
        • Kozlowski L.
        • Rothman S.K.
        • Yaster M.
        The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia: A double-blind, prospective, randomized, controlled study.
        Anesthesia and Analgesia. 2005; 100: 953-958
        • McCaffery M.
        • Pasero C.
        Assessment: Underlying complexities, misconceptions and practical tools.
        in: McCaffery M. Pasero C. Pain clinical manual. 2nd ed. Mosby, Baltimore1999: 35-102
        • McNeill J.A.
        • Sherwood G.D.
        • Starck P.L.
        • Thompson C.J.
        Assessing clinical outcomes: Patient satisfaction with pain management.
        Journal of Pain and Symptom Management. 1998; 16: 29-40
        • Melotti R.M.
        • Samolsky-Dekel B.G.
        • Ricchi E.
        • Chiari P.
        • di Giacinto I.
        • Carosi F.
        • di Nino G.
        Pain prevalence and predictors among inpatients in a major Italian teaching hospital. A baseline survey toward a pain free hospital.
        European Journal of Pain. 2005; 9: 485-495
        • Nelson K.L.
        • Yaster M.
        • Kost-Byerly S.
        • Monitto C.L.
        A national survey of American Pediatric Anesthesiologists: Patient-controlled analgesia and other intravenous opioid therapies in pediatric acute pain management.
        Anesthesia and Analgesia. 2010; 110: 754-760
        • Ng B.
        • Dimsdale J.E.
        • Shragg G.P.
        • Deutsch R.
        Ethnic differences in analgesic consumption for postoperative pain.
        Psychosomatic Medicine. 1996; 58: 125-129
        • Pasero C.
        • McCaffery M.
        No self-report means no pain-intensity rating: Assessing pain in patients who can not provide a report.
        American Journal of Nursing. 2005; 105: 50-53
        • Pierce C.A.
        • Voss B.
        Efficacy and safety of ibuprofen and acetaminophen in children and adults: A meta-analysis and qualitative review.
        The Annals of Pharmacotherapy. 2010; 44: 489-506
        • Riley III, J.L.
        • Robinson M.E.
        • Wise E.A.
        • Price D.D.
        A meta-analytic review of pain perception across the menstrual cycle.
        Pain. 1999; 81: 225-235
        • Robinson M.E.
        • Riley III, J.L.
        • Myers C.D.
        • Papas R.K.
        • Wise E.A.
        • Waxenberg L.B.
        • Fillingim R.B.
        Gender role expectations of pain: Relationship to gender differences in pain.
        The Journal of Pain. 2001; 2: 251-257
        • Rollman G.B.
        • Abdel-Shaheed J.
        • Gillespie J.M.
        • Jones K.S.
        Does past pain influence current pain: Biological and psychosocial models of sex differences.
        European Journal of Pain. 2004; 8: 427-433
        • Sarton E.
        • Olofsen E.
        • Romberg R.
        • den Hartigh J.
        • Kest B.
        • Nieuwenhuijs D.
        • Burm A.
        • Teppema L.
        • Dahan A.
        Sex differences in morphine analgesia: An experimental study in healthy volunteers.
        Anesthesiology. 2000; 93: 1245-1254
        • Suraseranivongse S.
        • Santawat U.
        • Kraiprasit K.
        • Petcharatana S.
        • Prakkamodom S.
        • Muntraporn N.
        Cross-validation of a composite pain scale for preschool children within 24 hours of surgery.
        British Journal of Anaesthia. 2001; 87: 400-405
        • Swafford L.I.
        • Allan D.
        Pain relief in the pediatric patient.
        Medical Clinics of North America. 1968; 52: 131-136
        • Taylor E.M.
        • Boyer K.
        • Campbell F.A.
        Pain in hospitalized children: A prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital.
        Pain Research and Management. 2008; 13: 25-32
      3. Texas Children’s Cancer Center (2011). Other pain assessment scales. Retrieved March 15, 2011, from

        • Unruh A.M.
        Gender variations in clinical pain experience.
        Pain. 1996; 65: 123-167
        • van Hulle Vincent C.
        • Denyes M.J.
        Relieving children’s pain: Nurses’ abilities and analgesic administration practices.
        Journal of Pediatric Nursing. 2004; 19: 40-50
      4. Vierhaus, M., Lohaus, A., & Schmitz, A. (2011). Sex, gender, coping, and self-efficacy: Mediation of gender differences in pain perception in children and adolescents. European Journal of Pain, 15,(6), 621.e1–e8.

      5. Wong on Web Archive (2008). FACES permission form. Retrieved March 27, 2012, from

        • Wong D.L.
        • Baker C.M.
        Pain in children: Comparison of assessment scales.
        The Oklahoma Nurse. 1988; 33: 8
        • Yaster M.
        Multimodal analgesia in children.
        European Journal of Anaesthesiology. 2010; 27: 851-857
        • Yaster M.
        • Billett C.
        • Monitto C.
        Intravenous patient controlled analgesia.
        in: Yaster M. Krane E.J. Kaplan R.F. Cote C.J. Lappe D.G. Pediatric pain management and sedation handbook. Mosby, St. Louis1997: 89-111
        • Yaster M.
        • Krane E.J.
        • Kaplan R.F.
        • Cote C.J.
        • Lappe D.G.
        in: Yaster M. Krane E.J. Kaplan R.F. Cote C.J. Lappe D.G. Pediatric pain management and sedation handbook. Mosby, St. Louis1997