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 Child’s 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. Article Summary This mixed-methods family-centered study identifies common themes, systems-related barriers and pain coping efficacy differences underlying pain experiences of Black and White children. What’s Known on This Subject Inequities exist in post-surgical pain and pain management of Black and White children. What This Study Adds Family perspectives regarding pain experience of NHB and NHW children highlight inter-group differences in stressors, barriers, pain coping and parent responses to child’s pain. Findings underscore the importance of family engagement and addressing systemic barriers to improve pain equity. Contributors Statement Chidambaran conceptualized and designed the study, conducted focus groups, coordinated and supervised data collection, analyses, and critically reviewed and revised the manuscript for important intellectual content. Mitchell conceptualized and designed the study, critically reviewed and revised the manuscript for important intellectual content. Kumar and Atkinson conducted subject recruitment, collected data, drafted the initial manuscript, critically reviewed and revised the manuscript, and designed the data collection instruments in REDCap, and analyzed the data. McLaughlin, Parikh and Chima participated in conduct of focus groups and maintained regulatory aspects of the study, critically reviewed and revised the manuscript Mende-Siedlecki helped design the study, critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Data Sharing Statement Deidentified individual participant data (including data dictionaries) will be made available, in addition to study protocols, the statistical analysis plan, and the informed consent form. The data will be made available upon publication to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal. Proposals should be submitted to vidya.chidambaran@cchmc.org .