Abstract This qualitative paper explores the perception of pain among north-eastern Thai children experiencing illness, aged from 4–18 years. Data was obtained from 17 children living in the community and 32 children admitted to two major hospitals in Isan, totaling 49 children. The qualitative data collection techniques used were observation, drawing, role-playing, story-telling, and “day conferences” (relaxed and informal group discussions). The study was conducted over 1 year and the data were analyzed using Fielding’s method of content analysis. The research found that children described their experience of pain as “disheartening”, “suffering”, and “torturing” and that the expression of pain in Isan families is characterized by avoidance and endurance. The findings suggest a role for a model of pain management in children specific to the sociocultural context of Isan, which focuses on family-centered care and acknowledges cultural diversity.