Mixed methods family-centered study of acute post-surgical pain experience in non-hispanic white and black children

Racial and neighborhood disparities in pediatric pain management are well-documented. This mixed-methods study engaged 19 Non-Hispanic Black (NHB) and 19 White (NHW) children with recent acute pain, along with their caregivers, to gain comprehensive insight into sociocultural factors and healthcare interactions impacting acute pediatric pain experiences. All children had acute post-surgical pain managed in tertiary care settings. Four focus groups per cohort (NHB and NHW) explored satisfaction with pain management, factors shaping pain experiences, and sociocultural beliefs surrounding pain and analgesia. Quantitative assessments included child measures of psychosocial factors, adverse childhood experiences (ACEs), pain coping, and resilience, alongside caregiver measures of socioeconomic status, pain catastrophizing, ACEs, racial and ethnic microaggressions (REMS), and responses to their child's pain. Qualitative data were analyzed using thematic coding (NVivo©) and integrated with quantitative analyses. Several key shared themes emerged: empathetic care, shared decision-making, and healthcare provider responsiveness enhanced satisfaction/trust in pain care, while insurance-related delays detracted from satisfaction. Among NHB dyads, additional negative influences included lack of pain validation, racial discrimination, and socioeconomic constraints. Both cohorts expressed opioid hesitancy, stoicism, and use of distraction-based pain coping strategies. These themes aligned with quantitative findings of higher deprivation index (p=.005), elevated REMS subscale scores-Assumptions of Inferiority (p=.01) and Similarity (p=.02), and greater ACEs (p=.02) in NHB vs. NHW caregivers. Personal adverse experiences potentially shaped higher protective responses to their child's pain (p=.005) in NHB (vs. NHW) caregivers. Our study sheds light on system-level factors that need to be addressed for an equitable pediatric pain experience. PERSPECTIVE: This mixed-methods study in NHB and NHW children with recent pain experiences and their caregivers highlights socioeconomic factors, racial bias, trust and healthcare provider interactions are important factors determining acute post-surgical pain experiences. Satisfaction with pain management, stoicism, distraction-based pain coping and hesitancy towards opioids were identified in both cohorts.