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Pain is the most common reason for seeking medical care. Yet treating it is often fraught with uncertainty and a powerful sense of risk in American medicine, particularly in the context of the ongoing opioid crisis. Clinical consensus about the best way to manage many forms of pain remains elusive, and risks ramify beyond individual patients themselves to entangle clinicians and even society at large. The language of "balancing risk" often frames discussions-in both clinical decision-making and public policy-about whether to prioritize relieving pain or preventing addiction and whether to privilege individual or public health. This article takes up the notion of balancing risk to explore the way in which it embeds assumptions about commensurability of profoundly different forms and scales of risk, imagining that they can be calculated, compared, and brought into some kind of give-and-take alignment with one another. Thinking with a "dignity of risk" lens, however, suggests other possible frames, moving us away from such fictive calculations of risk in contemporary pain care and toward a more patient-focused clarification of risk.

To explore parental perspectives regarding disclosure of child and parental adverse childhood experiences (ACE) and family unmet social needs (USN) and to elicit parental recommendations for screening in the pediatric medical home.We conducted a qualitative study using a purposive sample of English- and Spanish-speaking parents in our urban academic community clinic. Between January 2018 and March 2019, each parent underwent one semistructured interview that was audiotaped, transcribed, and independently coded in Atlas.ti by 2 study team members. Data analysis was based in constructivist grounded theory methodology to identify common themes and subthemes.We interviewed 25 English-speaking and 15 Spanish-speaking parents who were mostly female, racial/ethnic minorities with ≥1 ACE. English-speaking subjects were more likely to have a high school degree and be single parents. Four themes were identified: 1) Pediatricians should ask about ACE and USN. 2) Disclosure is a longitudinal process, not a discrete event. 3) Barriers to disclosure are significant, involving concrete and emotional risks for the family. 4) Trauma-informed providers and practices support disclosure.Families support pediatricians addressing ACE and USN in the medical home despite significant barriers. Even if providers screen using trauma-informed principles, parents may prefer not to disclose ACE initially because they regard disclosure as a stepwise process. These findings contribute to a new conceptual framework for thinking of ACE screening not merely as a way to generate information, but as an interactive, therapeutic relationship-building activity irrespective of whether or when it produces disclosure.