Pediatric chronic pain affects 1 in 5 children and adolescents in Canada. While equity-seeking groups (e.g., racialized minorities, lower socioeconomic status) are at higher risk for chronic pain, it is unclear whether pediatric pain differentially impacts the economic and healthcare resources of youth with pain in families of lower income. We examined medical expenses and healthcare utilization in dyads of youth with pain and their caregivers of annual income <$90,000 (n = 95) and >$90,000 (n = 200) attending a Canadian outpatient pain clinic. Caregivers reported on self and youth demographic information, mental health symptoms, and youth pain-related medical expenses and healthcare utilization (i.e., number of visits to general practitioners, specialists, non-physician care providers, emergency departments, inpatient admissions) in the past 3 months. Youth reported their pain intensity and pain interference. Caregiver anxiety, caregiver depression, and youth self-reported pain interference were measured using relevant subscales of the Patient-Reported Outcomes Measurement Information System (PROMIS). Medical expenses were measured using the Client Service Receipt Inventory for Adolescents with Chronic Pain. Results of chi-squares and t-tests showed that in the <$90,000 income group, proportionately more caregivers identified as non-White, reported chronic pain themselves, and had higher anxiety and depression symptoms than in the >$90,000 income group. In the <$90,000 income group, youth had higher parent-reported pain frequency and self-reported pain intensity than those in the >$90,000 income group. Youth pain-related expenses did not differ between income groups. The <$90,000 income group reported less youth pain-related visits to other therapists (e.g., naturopath, chiropractor) than the >$90,000 income group. Results of stratified regression analyses showed no significant predictors of healthcare utilization in either income group. Our findings indicate that, among families of youth with pain and with lower income, medical expenses associated with pediatric pain represent a larger proportion of their income, illustrating the need to address systemic social disparities for equity-seeking groups.