Mixed Methods Family Centered Study of Pain Experience in Non-Hispanic White and Black Children

Background and Objectives: Although racial disparities in pediatric pain have been described, family-centered research is lacking. This mixed-methods study aimed to understand race-specific factors impacting acute pain experiences in Non-Hispanic White (NHW) and Black (NHB) children. Methods: NHW and NHB children (aged 8-17) (n=19 each) with a recent acute pain experience, and their caregivers were recruited. The following domains were assessed in children (deprivation, ethnic identity, pain, psychosocial, pain coping, resilience) and caregivers (education, income, Racial and Ethnic Microaggressions Scale (REMS), Adverse Childhood Events (ACEs), Adult Response to Childs Symptoms). Questionnaire measures were compared between groups using simple statistical tests. Fifteen dyads participated in focus groups. Thematic codes underlying pain experiences were identified. Results: NHB children had similar pain/psychosocial characteristics but differed in ethnic identity (2.7 (0.5) vs. 2.2 (0.5); P=.002), deprivation index (0.4 (IQR 0.3-0.5) vs. 0.3 (IQR 0.2, 0.3), P=.007) and pain coping efficacy (8.6 (0.4) vs. 9.8 (0.5), P=.045) from NHW children. NHB caregivers scored higher on REMS sub-scales, ACEs (0 (0,1) vs 0 (0,0); P=.02) and Protection (1.9 (0.6) vs. 1.6 (0.5); P=.03) behaviors in response to child pain. NHB and NHW participants endorsed satisfaction with pain experiences, opioid avoidance, and stoicism. Unlike NHW participants, NHB reported barriers related to trust, discrimination, and access. Conclusions: Racial differences in acute pain experiences suggest healthcare providers need to reinforce trust and consider underlying cultural and pain coping differences when treating pain in NHB children. Findings emphasize that family-centered and systems-based approaches are important for equity in pediatric pain.